The purpose of this policy is to notify an individual of the uses and disclosures of protected health information that will be statutorily made by the covered entity. "An individual has a right to adequate notices of the uses and disclosures of protected health information that may be made by the covered entity".
ORGANIZATION shall formulate and implement a "Notice of Privacy Practices". The notice shall contain the rights that can be exercised by individuals with respect to the privacy of their PHI and the practices in safeguarding the same by ORGANIZATION
ORGANIZATION shall have the right to revise its privacy practices. Any such changes due to revision shall be duly revised in the Notice. The changes shall take effect only after revision and publication of the revised notice.
ORGANIZATION does not deem it necessary to distribute revised notices to individuals of prior revision times.
ORGANIZATION shall retain a record of each notice it issues for a period of six years from the date the notice was last in effect.
ORGANIZATION “Notice of Privacy Practices” will provide adequate information on:
Uses and disclosures of PHI that ORGANIZATION may make for the purposes of treatment, payment and healthcare operations.
A description of each of the other purposes for which ORGANIZATION is permitted to use or disclose PHI without the individual's written authorization.
If a use or disclosure for any purpose is prohibited or materially limited by other applicable law, the description of such use or disclosure shall reflect such applicable law.
A description of the types of uses and disclosures that require an authorization from the individual with a statement that other uses and disclosures not described in the notice will be made only with the individual’s written authorization, and that the individual shall have the right to revoke an authorization.
Detailed procedures with respect to contacting the individual when ORGANIZATION intends to raise funds and the individual’s right to opt out of such communications.
Uses and disclosures associated with group health plans and HMOs.
Legal obligations of this Organization with respect to handling protected health information (PHI).
Rights of the individual with respect to his PHI, restrictions on uses and disclosures that can be imposed or requested by the individual and the rights of, ORGANIZATION to accept or deny such requests.
Rights of the individual to request and receive his PHI through confidential communications, through electronic means or in physical form.
Rights of the individual to inspect and copy his PHI, right to request an account of disclosures and the right to request an amendment to PHI.
Rights of the individual to initiate a complaint to the Secretary of HHS, if such individual believes that the privacy polices practiced by ORGANIZATION are at variance with regulations. This shall include the procedures to file a complaint and along with a stated assurance that ORGANIZATION shall not retaliate against the individual for initiating a complaint. ORGANIZATION legal duties regarding privacy practices to maintain PHI and the requirement to notify affected individuals in case of breach of PHI.
Procedures to request further information on the Organization's privacy policies or submit complaints.
The notice shall contain the details of ORGANIZATION designated person, with title and contact number for the individuals to reach out for any further information.
A Notice of Privacy Practices will not be provided in the case of treatment of an inmate.
In the case where an individual is enrolled in a group health plan, the notice will be provided by the group health plan or by the insurance issuer or HMO.
ORGANIZATION will follow the procedures as mentioned below in providing the "Notice of Privacy Practices" to individuals.
Notice will be made available upon request to any person, even if such person is not receiving services from ORGANIZATION.
The notice will be provided no later than the date on which an individual is first provided with healthcare services or a transaction that involves PHI.
In cases of emergency treatment, the notice will be provided as soon as the emergency situation eases and will act in good faith.
The Notice of Privacy Practices may be delivered in paper or electronic form, at the time of receiving services or on the individual making a request for it or send it electronically , thus following any or a combination of the stated methods.
ORGANIZATION will post the Notice of Privacy Practices in a prominent place for individuals to access and read the same.
In the event when ORGANIZATION maintains a website, the notice will be made available on such website and will be available for download.
In case the notice is made available through email, the individual has the right to request the same in a paper copy.
ORGANIZATION will exercise its right to make changes to Notice of Privacy Practices any time. The revised Notice of Privacy Practices will be provided to all those individuals through appropriate means of communication.
Health Plan Requirements
The notice to individuals will be provided by the health plan no later than the compliance date for the health plan for all individuals then covered by the plan. Thereafter at the time of enrollment to individuals who are newly enrolled.
At least once every three years, the health plan will notify individuals then covered by the plan of the availability of the notice and how to obtain the notice.
In case of material changes to the notice, the health plan will prominently post the change or its revised notice on its web site by the effective date of the material change to the notice, and provide the revised notice, or information about the material change and how to obtain the revised notice, in its next annual mailing to individuals then covered by the plan.
In case the health plan that does not post its notice on a web site, will provide the revised notice, or information about the material change and how to obtain the revised notice, to individuals then covered by the plan within 60 days of the material revision to the notice.
ORGANIZATION will make a good faith effort to obtain each individual's written acknowledgment that the individual has received the Notice of Privacy Practices upon the individual's first receipt of health care items or services.
Except in an emergency, ORGANIZATION will make a good faith effort to obtain an individual's written acknowledgment of receipt of the Notice no later than the date of the first delivery of health care services to the individual, including services delivered electronically. If the Notice that is delivered electronically as part of first service or item delivery, the Organization will capture the individual's acknowledgment of receipt electronically.
If an individual refuses or otherwise fails to provide an acknowledgment, ORGANIZATION will document its good faith efforts to obtain the acknowledgment and the reason why the acknowledgment was not obtained. ORGANIZATION will not be prohibited from providing treatment or otherwise using or disclosing PHI as permitted by law if the individual does not sign an acknowledgment after having been asked to do so.
Only one signed acknowledgment is required per individual.
ORGANIZATION will maintain a practical means of keeping a log of all acknowledgements received.
ORGANIZATION will retain copies of any written acknowledgments of receipt of the Notice, or, if not obtained, documentation of its good faith efforts to obtain such written acknowledgment and will retain this documentation from the date of its creation until six years after the date when it was last in effect.
A model Notice of Privacy Practices is provided at the end of this document that may be customized by providing the necessary information and implemented.
NOTICE OF PRIVACY PRACTICES
Your Information. Your Rights. Our Responsibilities.
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.
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Include you in a hospital directory
• Provide mental health care
• Market our services and sell your information
• Raise funds
Our Uses and Disclosures
We may use and share your information as we:
• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us using the information provided on top of this notice.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes
In the case of fundraising:
• We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, on our web site, and we will mail a copy to you.
Vibrant Health Chiropractic LLC
213 N. Prospect ; 411 S. Rd
Cambridge, IL 61238
Privacy Official: Crystal Strode