NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION PURSUANT TO FEDERAL REGULATIONS. PLEASE REVIEW IT CAREFULLY.
1. INTRODUCTION
At Head2ToeHealth, LLC Practice, we understand that medical information about you and your health is personal. We are committed to protecting medical information about you.
We create a record of the care and services you receive directly from one of our physicians. We need this record to provide you with quality care and to comply with certain legal requirements.
This Notice of Privacy Practices (“Notice”) applies to all the records of your care generated by Practice.
This Notice will tell you about the ways in which Practice may use and disclose your protected health information (“PHI”). This Notice also describes your rights and certain obligations Practice has regarding the use and disclosure of PHI.
2. REGULATORY REQUIREMENTS
Practice is required by law to maintain the privacy of your PHI, to provide individuals with notice of Practice’s legal duties and privacy practices with respect to PHI, and to abide by the terms described in the Notice currently in effect.
3. YOUR RIGHTS
You have the following rights regarding your PHI:
Restrictions
You may request that Practice restrict the use and disclosure of your PHI.
To request restrictions, you must make your request in writing to our Privacy Officer using the applicable Practice form.
In your request, you must tell us:
(1) what information you want to limit;
(2) whether you want to limit our use, disclosure or both; and
(3) to whom you want the restrictions to apply, for example, disclosures to your spouse.
Alternative Communications
You have the right to request that communications of PHI to you from Practice be made by particular means or at particular locations.
For instance, you might request that communications be made at your work address, instead of your home address.
Your requests must be made in writing using Practice’s form and sent to the Privacy Officer. Practice will accommodate your reasonable requests.
Inspect and Copy
Generally, you have the right to inspect and copy your PHI that Practice maintains, provided you make your request in writing to Practice’s Privacy Officer.
If you request copies of your PHI, we may impose a reasonable fee to cover copying and postage.
If we deny access to your PHI, we will explain the basis for denial and your opportunity to have your request and the denial reviewed by a licensed health care professional (who was not involved in the initial denial decision) designated as a reviewing official.
If Practice does not maintain the PHI you request and if we know where that PHI is located, we will tell you how to redirect your request.
Amendment
If you believe that your PHI maintained by Practice is incorrect or incomplete, you may ask us to correct your PHI.
Your request must be made in writing, and it must explain why you are requesting an amendment to your PHI.
We can deny your request if your request relates to PHI:
(i) not created by Practice;
(ii) not part of the records Practice maintains;
(iii) not subject to being inspected by you; or
(iv) that is accurate and complete.
If your request is denied, we will provide you a written denial that explains the reason for the denial and your rights to:
(i) file a statement disagreeing with the denial;
(ii) if you do not file a statement of disagreement, submit a request that any future disclosures of the relevant PHI be made with a copy of your request and Practice’s denial attached; and
(iii) complain about the denial.
Accounting of Disclosures
You generally have the right to request and receive a list of the disclosures of your PHI we have made at any time during the six (6) years prior to the date of your request (provided that such a list would not include disclosures made prior to April 14, 2003).
The list will not include disclosures made:
(i) for treatment, payment and health care operations;
(ii) made to you;
(iii) for Practice’s patient list;
(iv) for national security or intelligence purposes; or
(v) to law enforcement officials.
You should submit any such request to Practice’s Privacy Officer.
Practice will provide the list to you at no charge, but if you make more than one request in a year you will be charged a fee of the costs of providing the list.
Right to Copy of Notice
You have the right to receive a paper copy of this notice upon request.
To obtain a paper copy of this notice, please contact the Privacy Officer at the address and contact information stated at the end of this notice.
4. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
Practice may use or disclose your PHI for the purposes described below without obtaining written authorization from you.
For Treatment
Practice may use and disclose PHI while providing, coordinating or managing your medical treatment, including the disclosure of PHI for treatment activities of another health care provider.
For Payment
Practice may use and disclose PHI to bill and collect payment for the health care services provided to you.
Practice may also disclose PHI to business associates such as billing companies and claims processing companies.
For Health Care Operations
Practice may use and disclose PHI as part of its operations, including:
quality assessment, staff evaluation, training, compliance, risk management, planning, credentialing, fraud detection, and administration.
As Required by Law and Law Enforcement
Practice may use or disclose PHI when required by law or in legal proceedings, and to law enforcement agencies under proper request.
Public Health Activities
Practice may disclose PHI for public health purposes such as disease control, reporting births or deaths, or notifying exposure risks.
Health Oversight Activities
Practice may disclose PHI for audits, investigations, inspections, and compliance monitoring.
Coroners, Medical Examiners, Funeral Directors
Practice may disclose PHI for identifying a decedent or determining cause of death.
Research
Practice may use and disclose PHI for research under certain circumstances.
Serious Threat to Health or Safety
Practice may disclose PHI to prevent or lessen a serious threat.
Specialized Government Functions
Practice may disclose PHI for military, national security, or protective services.
Disclosures to You / HIPAA Compliance
Practice may disclose your PHI to you or to the Secretary of the Department of Health and Human Services.
Patient List; Marketing
Unless you object, Practice may use your PHI for patient lists and marketing purposes.
Individuals Involved in Your Care
Practice may disclose PHI to family or others involved in your care unless you object.
5. OTHER USES AND DISCLOSURES
Other uses and disclosures of your PHI will be made only with your written authorization.
You have the right to revoke your authorization in writing.
6. RIGHT TO FILE A COMPLAINT
You may submit complaints regarding your privacy rights to:
You may also contact:
Office for Civil Rights
U.S. Department of Health and Human Services
You will not be penalized for filing a complaint.
7. DISCLAIMER
Disclaimer: While the information and guidance provided in this document is believed to be current and accurate at the time of posting, it is not intended to be and should not be construed to be or relied upon as legal, financial, or consulting advice. Before use, each document should be tailored to the unique nature of your practice, including applicable state law. Consult with an attorney and other advisors. References and links to third parties do not constitute an endorsement or sponsorship by the AMA, and the AMA hereby disclaims all express and implied warranties of any kind in the information provided.
