NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
In the course of providing services to you, Be Well Nutrition Counseling, PLLC (“Be Well Nutrition Counseling”) will obtain, record, and use mental health and medical information about you that is considered Protected Health Information, or “PHI.” PHI is defined as “individually identifiable health information” that is created or received by a healthcare provider and which relates to past, present, or future health, provision of healthcare, or payment for provision of healthcare and that either identifies the individual or could be used to identify the individual. HIPAA and other laws regulate the use and disclosure of PHI when it is transmitted electronically. This Notice describes Be Well Nutrition Counseling’s policies related to the use and disclosure of your PHI.
Uses and Disclosures Not Requiring Consent
Providing treatment services, collecting payment and conducting healthcare operations are necessary activities for quality care. State and federal laws allow us to use and disclose your health information for these purposes. In most cases, we are limited to disclosing the minimum information necessary to accomplish these purposes. To help clarify these terms, here are some examples:
• Treatment is when we use and disclose health information to provide, coordinate or manage your health care and other services related to your health care. If we decide to consult with another licensed health care provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist us in the diagnosis or treatment of your health condition. Disclosures for treatment purposes are not limited to the minimum necessary standard, because physicians and other health care providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of health care among health care providers or by a health care provider with a third party, consultations between health care providers, and referrals of a patient for health care from one health care provider to another.
• Payment is when we use and disclose health information to obtain reimbursement for your healthcare. Examples of payment are when we disclose your PHI to your health insurer to obtain reimbursement for your health care or to determine eligibility or coverage.
• Health Care Operations refers to the use and disclosure of health information for activities that relate to the performance and operation of our practice. Examples of health care operations are review of treatment procedures or business operations, quality assessment and improvement activities, and staff training.
PLEASE NOTE: I, or someone from Be Well Nutrition Counseling acting with my authority, may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. Your prior written authorization is not required for such contact.
Uses and Disclosures Requiring Authorization
We may use or disclose PHI for purposes outside of treatment, payment, or health care operations when your appropriate authorization is obtained. In those instances when we are asked for information for purposes outside of treatment, payment or health care operations, we will obtain an authorization from you before releasing this information. You may revoke all such authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) we have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the insurer the right to contest the claim under the policy. To revoke any authorizations, email Ana Pruteanu at email@example.com.
When it comes to your PHI, you have certain rights. This section explains your rights and some of Be Well Nutrition Counseling’s responsibilities to help you.
• Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of protected health information regarding you. The request must be in writing, and we are not required to agree to a restriction you request.
• Right to Receive Confidential Communications by Alternative Means and at Alternative Locations: You have the right to request and receive confidential communications of PHI by alternative means and at alternative locations. (For example, you may not want a family member to know that you are seeing me. On your request, we will send your bills to another address.)
• The Right to Get a List of the Disclosures we have made, You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an Authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a reasonable cost based fee for each additional request.
• Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.
• Right to a Paper Copy: You have the right to obtain a paper copy of the notice from us upon request, even if you have agreed to receive the notice electronically.
• Right to Restrict Disclosures When You Have Paid for Your Care Out-of-Pocket: You have the right to restrict certain disclosures of PHI to a health plan when you pay out-of-pocket in full for our services.
As a health care provider, I have certain duties to you related to your PHI. These are described below.
• I am required by law to maintain the privacy of PHI and to provide you with a notice of my legal duties and privacy practices with respect to PHI.
• I am required to notify you if: (a) there is a breach (a use or disclosure of your PHI in violation of the HIPAA Privacy Rule) involving your PHI; (b) that PHI has not been encrypted to government standards; and (c) my risk assessment fails to determine that there is a low probability that your PHI has been compromised.
• I reserve the right to change the privacy policies and practices described in this notice. Unless I notify you of such changes, however, I am required to abide by the terms currently in effect.
• If I revise my policies and procedures, I will send a revised Notice of Privacy Practices by mail or email to the address I have in your record.
Questions and Complaints
If you have questions about this notice, disagree with a decision I make about access to your records, or have other concerns about your privacy rights, you may contact Ana Pruteanu, at 312-612-0998 or firstname.lastname@example.org. If you believe that your privacy rights have been violated and wish to file a complaint with my office, you may send your written complaint to Ana Pruteanu, email@example.com
EFFECTIVE DATE OF THIS NOTICE - APRIL 2023