THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Effective Date March 12, 2021
A. PURPOSE OF THIS NOTICE
The Wellness Group for Voice, Speech, and Swallowing, LLC (The Wellness Group) is committed to preserving the privacy of your health information as required by law. The Wellness Group is required to provide this Notice of Privacy Practices (“Notice”) to you. The Notice tells you how we can and cannot use and disclose the health information that you have given to us or that we have learned about you when you were a patient. It also tells you about your rights and our legal duties concerning your health information.
The Wellness Group is required to abide by this Notice and any future changes to the Notice that we are required or authorized by law to make. This Notice applies to the practices of:
• All The Wellness Group employees, volunteers, students, and service providers, including clinicians, who have access to health information.
• Any health care professional authorized to enter information into your health record at The Wellness Group.
B. USES AND DISCLOSURES OF HEALTH INFORMATION
The following section describes different ways that we use and disclose health information for treatment, payment and health care operations. Not every use or disclosure will be noted and there may be incidental disclosure that are a by-product of the listed uses and disclosures. The ways we use and disclose health information will fall within one of the categories.
a. For Treatment. We may use your health information to provide you with treatment or services. We may disclose your health information to staff and other personnel involved in your health care. Treatment includes (a) activities performed by health care professionals providing care to you or coordinating or managing your care with third parties and (b) consultations with and between The Wellness Group providers and other health care providers.
b. For Payment. We may use and disclose your health information so that we may bill and collect payment from you, an insurance company, or someone else for health care services you receive from The Wellness Group. We also may tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will pay for the treatment.
c. For Health Care Operations. We may use and disclose your health information in order to run the necessary administrative, educational, quality assurance and business functions at The Wellness Group.
C. OTHER PERMITTED USES AND DISCLOSURES OF HEALTH INFORMATION
We may use or disclose your health information without your permission in the following circumstances, subject to all applicable legal requirements and limitations:
1. Required By Law. As required by federal, state, or local law.
2. Public Health Activities. For public health reasons in order to prevent or control disease, injury or disability; or to report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications, school immunizations under certain circumstances or problems with products.
3. Victims of Abuse, Neglect or Domestic Violence. To a government authority authorized by law to receive reports of abuse, neglect or domestic violence when we reasonably believe you are the victim of abuse, neglect or domestic violence and other criteria are met.
4. Health Oversight Activities. To a health oversight agency for audits, investigations, inspections, licensing purposes, or as necessary for certain government agencies to monitor the health care system, government programs, and compliance with civil rights laws.
5. Lawsuits and Disputes. In response to a subpoena, discovery request or a court or administrative order, if certain criteria are met.
6. Law Enforcement. To a law enforcement official for law enforcement purposes as required by law; in response to a court order, subpoena, warrant, summons or similar process; for identification and location purposes if requested; to respond to a request for information on an actual or suspected crime victim; to report a crime in an emergency; to report a crime on The Wellness Group premises; or to report a death if the death is suspected to be the result of criminal conduct.
7. Coroners, Medical Examiners and Funeral Directors. To a coroner or medical examiner, (as necessary, for example, to identify a deceased person or determine the cause of death) or to a funeral director, as necessary to allow him/her to carryout his/her activities.
8. Organ and Tissue Donation. To organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facilitate a donation and transplantation.
9. Research. For research purposes under certain limited circumstances. Research projects are subject to a special approval process. Therefore, we will not use or disclose your health information for research purposes until the particular research project, for which your health information may be used or disclosed, has been approved through this special approval process.
10. Serious Threat to Health or Safety; Disaster Relief. To appropriate individual(s)/organization(s) when necessary (i) to prevent a serious threat to your health and safety or that of the public or another person, or (ii) to notify your family members or persons responsible for you in a disaster relief effort.
11. Military. To appropriate domestic or foreign military authority to assure proper execution of a military mission, if required criteria are met.
12. National Security; Intelligence Activities; Protective Service. To federal officials for intelligence, counterintelligence, and other national security activities authorized by law, including activities related to the protection of the President, other authorized persons or foreign heads of state, or related to the conduct of special investigations.
13. Inmates. To a correctional institution (if you are an inmate) or a law enforcement official (if you are in that person’s custody) as necessary (a) to provide you with health care; (b) to protect your or others’ health and safety; or (c) for the safety and security of the correctional institution.
14. Workers’ Compensation. As necessary to comply with laws relating to workers’ compensation or similar work-related injury program.
D. WHEN WRITTEN AUTHORIZATION IS REQUIRED
Other than for those purposes identified above in Sections B and C, we will not use or disclose your health information for any purpose unless you give us your specific written authorization to do so. Special circumstances that require an authorization include most uses and disclosures of your psychotherapy notes, certain disclosures of your test results for the human immunodeficiency virus or HIV, uses and disclosures of your health information for marketing purposes that encourage you to purchase a product or service, and for sale of your health information with some exceptions. If you give us authorization, you can withdraw this written authorization at any time. To withdraw your authorization, deliver or fax a written revocation to The Wellness Group; fax: 503-461-9871. If you revoke your authorization, we will no longer use or disclose your health information as allowed by your written authorization, except to the extent that we have already relied on your authorization.
E. YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have certain rights regarding your health information which we list below. In each of these cases, if you want to exercise your rights, you must do so by submitting in writing to The Wellness Group. In some cases, we may charge you for the costs of providing materials to you. You can get information about how to exercise your rights and about any costs that we may charge for materials by contacting the The Wellness Group at 503-946-6907.
1. Right to Inspect and Copy. With some exceptions, you have the right to inspect and get a copy of the health information that we use to make decisions about your care. For the portion of your health record maintained in our electronic health record, you may request we provide that information to or for you in an electronic format. If you make such a request, we are required to provide that information for you electronically (unless we deny your request for other reasons). We may deny your request to inspect and copy in certain limited circumstances, and if we do this, you may ask that the denial be reviewed.
2. Right to Amend. You have the right to amend your health information maintained by or for The Wellness Group, or used by The Wellness Group to make decisions about you. We will require that you provide a reason for the request, and we may deny your request for an amendment if the request is not properly submitted or if it asks us to amend information that (a) we did not create (unless the source of the information is no longer available to make the amendment); (b) is not part of the health information that we keep; (c) is of a type that you would not be permitted to inspect and copy; or (d) is already accurate and complete.
3. Right to an Accounting of Disclosures. You have the right to request a list and description of certain disclosures by The Wellness Group of your health information.
4. Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you (a) for treatment, payment, or healthcare operations, (b) to someone who is involved in your care or the payment for it, such as a family member or friend, or (c) to a health plan for payment or health care operations purposes when the item or service for which The Wellness Group has been paid out of pocket in full by you or someone on your behalf (other than the health plan). Except for the request noted in 4(c) above, we are not required to agree to your request. Any time The Wellness Group agrees to such a restriction, it must be in writing and signed by a designee at The Wellness Group.
5. Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain place. The Wellness Group will accommodate reasonable requests.
6. Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice, whether or not you may have previously agreed to receive the Notice electronically.
7. Right to be Notified of a Breach. You have the right to be notified if there is a breach – a compromise to the security or privacy of your health information –due to your health information being unsecured. The Wellness Group is required to notify you within 60 days of discovery of a breach.
F. REVISIONS TO THIS NOTICE
We have the right to change this Notice and to make the revised or changed Notice effective for health information we already have about you, as well as any information we receive in the future. Except when required by law, a material change to any term of the Notice may not be implemented prior to the effective date of the Notice in which the material change is reflected. The Wellness Group will post the revised Notice on its website and provide you a copy of the revised notice upon your request.
G. QUESTIONS OR COMPLAINTS
If you have any questions about this Notice, please contact The Wellness Group 503-946-6907. If you believe your privacy rights have been violated, you may file a complaint with The Wellness Group or with the Secretary of the Department of Health and Human Services. To file a complaint with The Wellness Group, contact 503-946-6907. You will not be penalized for filing a complaint.
This Notice tells you how we may use and share health information about you. If you would like a copy of this Notice, please ask your health care provider.
H. Inclusive Client Care and Communication
The Wellness Group is committed to providing inclusive client care. The Wellness Group complies with applicable state and federal civil rights laws and does not discriminate, exclude people or treat them differently on the basis of:
• National origin
If you believe that The Wellness Group has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance, Phone: 503-946-6907, Fax: 503-461-9871, Email: firstname.lastname@example.org. You can file a grievance in person or by phone, fax, or email.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue SW., Room 509F, HHH Building, Washington, D.C. 20201, 800-868-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
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