HIPAA NOTICE OF PRIVACY PRACTICES
LIVING WELL CENTER FOR INTEGRATIVE HEALTH
1 MARKET PLACE UNIT 27
ESSEX JUNCTION, VT 05452
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.
If you have any questions about this notice, please contact our Office Manager at 802-658-6092 or via email admin@livingwellvt.com
UNDERSTANDING YOUR HEALTH RECORD/INFORMATION
Each time you visit our office, a record of your visit is made. Typically, this record contains your symptoms, any examination or test results, diagnosis, treatment, and a plan for future care or treatment. This information often referred to as your health or medical record, serves as a basis for planning your care and treatment and serves as a means of communication among the health professionals who contribute to your care. Below is a description of your rights regarding your record that is maintained in our office, as well as a summary of our obligations and responsibility.
YOUR MEDICAL INFORMATION RIGHTS
Though your health record is the physical property of Living Well Center for Integrative Health (“Living Well”), you have the following rights with respect to the information included in the record:
Receive a Copy of this Notice: You have a right to receive this notice of Living Well’s Privacy Practices from us at any time.
Inspect and Copy Medical Information in Your Record: You have the right to see or get a copy (electronic or written) of your medical information. A request to access or for a copy of your medical information can be made to our Front Desk Staff or to your Provider in writing. Under limited circumstances, Living Well may deny your request for your medical information but we will provide you with an explanation for such a denial. You also have the right to obtain a copy or forward a copy of your medical information to a third party in the form and format requested, if readily producible, by providing Living Well with a written and signed authorization that specifies the third party to whom the medical information is being sent, as well as the location where the medical information is to be sent. Living Well will provide you with access to or a copy of your medical information usually within 30 days of your request. A reasonable fee may be charged for copying and labor costs.
Amend Medical Information in Your Record: You can ask Living Well to correct health information that you think is incorrect or incomplete. Please note that we may deny your request to correct or complete medical information in the following circumstances:
The medical information was not created by Living Well (unless you provide a reasonable basis to believe the originator of the medical information is no longer available to act on the requested amendment)
The medical information is not part of your medical or billing records
The medical information is already accurate or complete
Living Well will provide you with a response regarding your request for an amendment to your medical information within 60 days from your request.
Request Restrictions on Certain Uses and Disclosures of Your Medical Information: You have the right to ask us to limit what medical information of yours we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. Living Well reserves the right to deny your request to restrict the use of disclosure of medical information. We are not required to agree to your request for restrictions if it is not feasible for us to ensure our compliance or believe it will negatively impact the care we may provide you. Living Well must comply with a request from you that medical information not be disclosed to a health plan for payment or health care operations if you have paid in full for the services provided and if such a disclosure to the health plan is not required by law.
Receive Communications of Medical Information in Confidence: You have a right to ask us to contact you in a specific way (for example on your work or on your home phone) or to send mail to a specific address. Living Well shall agree to any reasonable request for such an accommodation.
Receive an Accounting of Disclosures: You can ask Living Well for a list accounting the times that we have disclosed your medical information. The list will include disclosures made during the six years prior to your request, who we shared the information with, and why we shared the information. This list will not include the disclosures for the following purposes:
To carry out treatment, payment, and healthcare operations
To correctional institutions or law enforcement officials as provided by law
For national security or intelligence purposes
Incidental to other permissible uses or disclosures
That is part of a limited data set (does not contain medical information that directly identifies individuals)
Made to you or your personal representatives
For which you have provided a written authorization
Provide a Written Authorization and/or Revoke Your Written Authorization to Use or Disclose Medical Information: You may provide Living Well with written authorization to use or disclose medical information for purposes other than those described in this notice. You also have a right to revoke any written authorization you provide to Living Well for the use or disclosure of medical information, except to the extent that we have already taken action in reliance on your authorization. Living Well shall not honor a revocation if your written authorization was obtained as a condition of getting insurance coverage, and other applicable law provides the insurer that obtained the authorization with the right to contest a claim under the policy.
File a Complaint: You have a right to file a complaint if you feel we have violated your rights. You can file a complaint with us by using the contact information at the top of this notice, or you can file a complaint with the US Department of Health and Human Services, Office of Civil Rights by sending a letter to 200 Independence Avenue, S.W.; Washington, DC 20201 by calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints Living Well shall not retaliate against you for filing a complaint.
Choose Someone to Act For You: If you have executed a medical power of attorney, an advanced directive or if you have a legal guardian, that person has the right to exercise your rights with regard to your medical information. You may also choose to tell Living Well to share information with your family, close friends, or other individuals, identified by you, who are involved in your care. Please note that if you are not able to tell us whether to share information with family, friends, or others involved in your care, we may go ahead and share your information with these individuals 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.
HOW YOUR MEDICAL INFORMATION MAY BE USED OR DISCLOSED
Except for the uses and disclosures discussed in this notice, your medical information will not be used or disclosed without your written authorization. Living Well may use or disclose your medical information for the following purposes without written authorization:
Treatment: Living Well may use and disclose your medical information in the provision, coordination, or management of your health care, for purposes such as consultations between health care providers regarding your care.
Payment: Living Well may use and disclose your medical information to obtain reimbursement for the health care provided to you, including for determination of eligibility and coverage, and other utilization review activities.
Healthcare Operations: Living Well may use and disclose your medical information to support functions of our practice, improve your care, and contact you when necessary. Healthcare Operation activities include quality assurance activities, case management, receiving and responding to patient complaints, physician reviews, compliance programs, audits, business planning, development, management, and administrative activities.
Appointment Reminders: Living Well may contact you to provide appointment reminders. Please let us know if you do not wish to have us contact you concerning your appointment, or if you wish to have us use a different telephone number or address to contact you for this purpose.
Individuals Involved in Your Care of Payment for Your Care: Unless you object, Living Well may disclose your medical information to your family or friends or any other individual identified by you when they are involved in your care or the payment for your care. We shall only disclose the medical information directly relevant to that other individual’s involvement in your care or payment. We may also disclose your medical information to notify a person responsible for your care of your location, general condition, or death.
Business Associates: There may be some services provided in our organization through contracts with Business Associates. We may disclose some or all of your medical information to our Business Associates so that they can perform the job we have asked them to do. To protect your medical information, we require the Business Associate to appropriately safeguard your medical information by following all required federal regulations.
Health Oversight Activities: We may disclose your medical information to Federal or State Agencies that oversee our activities. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
Workers’ Compensation: Living Well may release your medical information to programs that provide benefits for work-related injuries or illness as necessary pursuant to and in compliance with Workers’ Compensation law.
Public Health and Safety Issues: We may disclose medical information about you in the following circumstances:
To a public health authority that is permitted by law to collect or receive the information for purposes such as controlling disease, injury, or disability
To help with product recalls
To report adverse reactions to medication, food, supplements, or products
To report child abuse or neglect
To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
Abuse or Neglect: Living Well may report the suspected abuse, neglect, or domestic violence of a patient. We will make this disclosure only if the patient agrees or when required or authorized by law.
Serious Threats: As permitted by applicable law and standards of ethical conduct, we may use and disclose your medical information if we, in good faith, believe that the use of disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
Law Enforcement: Living Well may disclose your medical information as required by law or in response to a valid judge-ordered subpoena or warrant. For example, we may disclose your medical information in cases of where you are suspected to be a victim of a crime or to identify or locate a suspect, fugitive, material witness, or missing person.
Coroners, Health Examiners, and Funeral Directors: We may release your medical information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients to Funeral Directors as necessary to carry out their duties.
National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
As Required by Law: Living Well may disclose your medical information as required or as authorized by law.
The following uses and disclosures will be made only with written authorization from you:
Medical information for marketing purposes
Disclosures that constitute a sale of your medical information
Other uses and disclosures are not described in this notice.
OUR RESPONSIBILITIES
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 have copies available to you.
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.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.
NOTICE OF PRIVACY PRACTICE AVAILABILITY
This notice will be available at the Living Well Front Desk and on our website. You may obtain a printed copy by asking a member of the Living Well Front Desk staff.
Updated: November 1, 2021