Integrative
Health Specialists of
Notice
of Privacy Practices
This
notice describes how medical information about you may be used and disclosed and
how you can get access to this information. Please review it carefully. This
Notice of Privacy Practices describes how we may use and disclose your protected
health information to carry out treatment, payment or health care operations and
for other purposes that are permitted or required by law. It also describes your
rights to access and control your protected health information. “Protected
health information” is information about you, including demographic information,
that may identify you and that relates to your past, present or future physical
or mental health or condition and related health care services. We are required by law to maintain the
privacy of your protected health information and to provide you with notice of
our legal duties and privacy practices with respect to protected health
information. We are required to abide by
the terms of this Notice of Privacy Practices. We may change the terms of our
notice, at any time. The new notice will be effective for all protected health
information that we maintain at that time. Upon your request, we will provide
you with any revised Notice of Privacy Practices. You can obtain the revised notice by calling
the office and requesting that a revised copy be sent to you in the mail or
asking for one at the time of your next appointment.
You
may also obtain a copy of the revised notice by visiting our Website at:
www.healthyindy.com.
1.
Uses and Disclosures of Protected Health
Information
Uses
and Disclosures of Protected Health Information Your
protected health information may be used and disclosed by your physician, our
office staff and others outside of our office that are involved in your care and
treatment for the purpose of providing health care services to you. Your
protected health information may also be used and disclosed to pay your health
care bills and to support the operation of the physician’s practice. Following are examples of the types of uses
and disclosures of your protected health care information that the physician’s
office is permitted to make. These examples are not meant to be exhaustive, but
to describe the types of uses and disclosures that may be made by our office.
Treatment:
We will use and disclose your protected health information to provide,
coordinate, or manage your health care and any related services. This includes
the coordination or management of your health care with
a third party that has already obtained your permission to have access to your
protected health information. For example, we would disclose your protected
health information, as necessary, to a home health agency that provides care to
you. We will also disclose protected health information to other physicians who
may be treating you when we have the necessary permission from you to disclose
your protected health information. For example, your protected health
information may be provided to a physician to whom you have been referred to
ensure that the physician has the necessary information to diagnose or treat
you. In addition, we may disclose your
protected health information from time-to-time to another physician or health
care provider (e.g., a specialist or laboratory) who, at the request of your
physician, becomes involved in your care by providing assistance with your
health care diagnosis or treatment to your physician.
Payment:
Your protected health information will be used, as needed, to obtain payment for
your health care services. This may include certain activities that your health
insurance plan may undertake before it approves or pays for the health care
services we recommend for you such as making a determination of eligibility or
coverage for insurance benefits, reviewing services provided to you for medical
necessity, and undertaking utilization review activities. For example, obtaining
approval for a hospital stay may require that your relevant protected health
information be disclosed to the health plan to obtain approval for the hospital
admission.
Healthcare
Operations:
We may use or disclose, as-needed, your protected health information in order to
support the business activities of your physician’s practice. These activities
include, but are not limited to, quality assessment activities, employee review
activities, training of medical students, licensing, marketing and fundraising
activities, and conducting or arranging for other business activities. For example, we may disclose your protected
health information to medical school students that see patients at our office.
In addition, we may use a sign-in sheet at the registration desk where you will
be asked to sign your name and indicate your physician. We may also call you by
name in the waiting room when your physician is ready to see you. We may use or
disclose your protected health information, as necessary, to contact you to
remind you of your appointment. This
contact may include, but is not limited to, leaving voice mail messages, email
messages or messages with other members of your household. You may
request that we not use any or all of these methods to contact you. We will share your protected
health information with third party “business associates” that perform various
activities (e.g., billing, transcription services) for the practice. Whenever an
arrangement between our office and a business associate involves the use or
disclosure of your protected health information, we will have a written contract
that contains terms that will protect the privacy of your protected health
information. We may use or disclose your
protected health information, as necessary, to provide you with information
about treatment alternatives or other health-related benefits and services that
may be of interest to you. We may also use and disclose your protected health
information for other marketing activities. For example, your name and address
may be used to send you a newsletter about our practice and the services we
offer. We may also send you information about products or services that we
believe may be beneficial to you. You may contact our Privacy Contact to request
that these materials not be sent to you.
Uses and
Disclosures of Protected Health Information Based upon Your Written Authorization 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, at any time, in writing,
except to the extent that your physician or the physician’s practice has taken
an action in reliance on the use or disclosure indicated in the
authorization. Other Permitted and
Required Uses and Disclosures That May Be Made With
Your Consent Authorization or
Others
Involved in Your Healthcare:
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.
Other
Permitted and Required Uses and Disclosures That May Be Made Without Your
Consent, Authorization or
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, as
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. The disclosure will be made for the purpose of
controlling disease, injury or disability. We may also disclose your protected
health information, if directed by the public health authority, to a foreign
government agency that is collaborating with the public health authority.
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 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 to report adverse events, product
defects or problems, biologic product deviations, 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), 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 the
practice, and (6) medical emergency (not on the 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 when 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.
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:
Your protected health information may be disclosed by us as authorized to comply
with workers’ compensation laws and other similar legally-established programs.
Inmates:
We may use or disclose your protected health information if you are an inmate of
a correctional facility and your physician created or received your protected
health information in the course of providing care to you.
Required
Uses and Disclosures:
Under the law, we must make disclosures to you and when required by the
Secretary of the Department of Health and Human Services to investigate or
determine our compliance with the requirements of Section 164.500 et. seq.
2.
Your Rights
Following
is a statement of your rights with respect to your protected health information
and a brief description of how you may exercise these rights.
You
have the right to inspect and copy your protected health
information.
This means you may inspect and obtain a copy of protected health information
about you that is contained in a designated record set for as long as we
maintain the protected health information. A “designated record set” contains
medical and billing records and any other records that your physician and the
practice uses for making decisions about you. Under federal law, however, you may not
inspect or copy the following records; psychotherapy notes; information compiled
in reasonable anticipation of, or use in, a civil, criminal, or administrative
action or proceeding, and protected health information that is subject to law
that prohibits access to protected health information. Depending on the
circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to
have this decision reviewed. Please contact our Privacy Contact if you have
questions about access to your medical record.
You
have the right to request a restriction of your protected health
information.
This means you may ask us not to use or disclose any part of your protected
health information for the purposes of treatment, payment or healthcare
operations. You may also request that any part of your protected health
information not be disclosed to family members or friends who may be involved in
your care or for notification purposes as described in this Notice of Privacy
Practices. Your request must state the specific restriction requested and to
whom you want the restriction to apply.
Your physician is not required to agree to a restriction that you may
request. If physician believes it is in your best interest to permit use and
disclosure of your protected health information, your protected health
information will not be restricted. If your physician does agree to the
requested restriction, we may not use or disclose your protected health
information in violation of that restriction unless it is needed to provide
emergency treatment. With this in mind, please discuss any restriction you wish
to request with your physician. You may request a restriction by calling the
Privacy Officer at (317) 580-9333.
You
have the right to request to receive confidential communications from us by
alternative means or at an alternative location.
We will accommodate reasonable requests. We may also condition this
accommodation by asking you for information as to how payment will be handled or
specification of an alternative address or other method of contact. We will not
request an explanation from you as to the basis for the request. Please make
this request in writing to our Privacy Contact.
You
may have the right to have your physician amend your protected health
information.
This means you may request an amendment of protected health information about
you in a designated record set for as long as we maintain this information. You
will be required to make this request in writing. We have forms available in our office for
this purpose. In certain cases, we may
deny your request for an amendment. If we deny your request for amendment, you
have the right to file a statement of disagreement with us and we may prepare a
rebuttal to your statement and will provide you with a copy of any such
rebuttal. Please contact our Privacy Contact to determine if you have questions
about amending your medical record.
You
have the right to receive an accounting of certain disclosures we have made, if
any, of your protected health information.
This right applies to disclosures for purposes other than treatment, payment or
healthcare operations as described in this Notice of Privacy Practices. It
excludes disclosures we may have made to you, for a facility directory, to
family members or friends involved in your care, or for notification purposes.
You have the right to receive specific information regarding these disclosures
that occurred after
You
have the right to obtain a paper copy of this notice from
us,
upon request, even if you have agreed to accept this notice electronically.
3.
Complaints
You
may complain to us or to the Secretary of Health and Human Services if you
believe your privacy rights have been violated by us. You may file a complaint
with us by notifying our Privacy Officer of your complaint. We will not
retaliate against you for filing a complaint.
You
may contact our Privacy Officer, Jennifer
Berry at (317)-580-9333 for further information about the
complaint process. This notice was
published and becomes effective on