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.

In the course of providing healthcare to you, we collect, make, use, store and disclose information about you and your healthcare. Federal and State law require that when health information about a person can be used to identify that person, the privacy of that health information must be protected. For this reason, such health information is known as “Protected Health Information”, or “PHI” for short.

Breath Mind Body Therapy is required by law to give you our Notice of Privacy Practices (NPP) to tell you how we will use and disclose your PHI, our practices to protect it, and your rights. The NPP is provided to you jointly by Breath Mind Body Therapy and its employees, staff and others, within and outside its operations, who we permit through an organized healthcare arrangement to be involved in your treatment, payment for services, and in our operations. All such persons and entities that join in the NPP may use and disclose information about you as described herein. We are allowed to change the NPP if we deem necessary. We will follow the terms of the most current version of the NPP we have published. Any revised version of the NPP will be effective for all PHI we maintain at the time of the revision and which we receive or create thereafter. You may request a copy of the most current version of the NPP or find it at breathemindbodytherapy.com. 

How We Use and Disclose Your PHI

Use and Disclosure of Your PHI Without Your Authorization

Circumstances when we might use and disclose your PHI, or the purposes for doing so, are set forth below, along with some examples. But you should understand that not all circumstances, can or will be listed and described, and not every example can or will be provided.

For Treatment. We may use your PHI within our organization and disclose it to others outside our organization for purposes related to your healthcare. For example, your PHI may be used to create and carry out a plan of treatment for you or to others we may refer you to for evaluation or treatment.

For Payment. We may use or disclose your PHI to obtain payment for healthcare services you receive. For example, we may use and disclose PHI in billing your health insurance plan for healthcare services provided to you.  

For Healthcare Operations. We may use and disclose PHI in order to manage our programs and activities. For example, we may use PHI to review the quality of services you receive from us, or disclose it to accreditation organizations for the purpose of obtaining and/or maintaining accreditation.

Appointments and Other Health Information. We may send you reminders of healthcare appointments. We may send you information about health services that may be of interest to you.

Disclosures to Family, Friends and Others. We may disclose PHI to your family, or close personal friends or other persons who are involved in your medical care and/or the payment for it. In these cases, we will ask you to sign a Release of Information.

For Disaster Relief Purposes. We may disclose PHI to government agencies for the purpose of notifying family members or close personal friends about an individual’s medical condition. (You have a right to object to the sharing of information for this purpose.)

To Business Associates. We may disclose PHI to certain entities or individuals outside our organization that we engage to perform services on our behalf, provided they agree to appropriately safeguard the privacy of the PHI.

Other Uses and Disclosures: We are also permitted or may be required by law to use or disclose your personal health information, without your authorization, in the following circumstances:

For any purpose required by law.

For public health activities, for example, reporting of disease, injury, birth, death or suspicion of child abuse or neglect.

To a governmental authority or for a government program. For example, to determine benefit eligibility.

For health oversight activities. For example, audits, inspections, licensure actions or civil, administrative or criminal proceedings or actions.

For judicial or administrative proceedings. For example, pursuant to a court order or a subpoena.

For law enforcement purposes. For example, reporting wounds or injuries or for identifying or locating suspects, witnesses, or missing people.

To coroners and funeral directors.

To avert a serious threat to health or safety under certain circumstances.

To the military about its members or veterans; to government agencies for intelligence or national security purposes; to a correctional institution or a law enforcement official about an inmate or an individual in custody.

For compliance with workers’ compensation programs.

Other Uses and Disclosures Require Your Written Authorization Except for the circumstances mentioned above, we will ask you for your written authorization before using or disclosing PHI. If you provide us with such an authorization, you may cancel it at any time in writing. If you cancel an authorization, we cannot take back any uses or disclosures which we had already made with your authorization.

Your Rights Concerning Your PHI.  The following is a summary of your rights with respect to your PHI:

Breathe Mind Body Therapy will charge a reasonable, cost-based fee of 25 cents per page.

You have the right to inspect and/or receive a copy of your PHI, as permitted by law. Requests must be submitted in writing. Breathe Mind Body Therapy will provide a copy or summary of you PHI within 30 days of your request. If it takes longer, Breathe Mind Body Therapy will notify you no later than within 30 days, explaining the delay and an estimate time when it will be available. 

You have the right to request restrictions regarding the uses and disclosures of your PHI.   

You can ask  not  to use or share certain health information for treatment, payment, or operations. Breathe Mind Body Therapy is not required to agree to your request, and may say “no” if it would affect your care.  If you pay for a service or health care items out-of-pocket in full, you can ask not to share that information for the purpose of payment or operations with your health insurer.  Breathe Mind Body Therapy will say “yes” unless a law requires me to share that information. 

You have the right to a request to receive confidential communications. You can ask Breathe Mind Body Therapy to contact you in a specific way (for example, home or office phone) or to send mail to a different address.  All reasonable requests will be consented. 

You have the right to request that Breathe Mind Body Therapy amend or correct your PHI. Requests must be made in writing. Your request must state a reason for the requested amendment. Breathe Mind Body Therapy may say “no” to your request, and will tell you why in writing within 60 days. 

You have the right to receive an accounting of certain disclosures Breathe Mind Body Therapy has made, if any, of your PHI. Requests must be submitted in writing. Breathe Mind Body Therapy will provide a copy or summary to you within 30 days of your request.

You have the right to obtain a paper copy of our Notice of Privacy Practices from Breathe Mind Body Therapy.

You have the right to 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.  Breathe Mind Body Therapy will make sure that person has this authority and can act for you before taking any action. 

Complaints. If you believe the privacy of your PHI has not been properly protected or your privacy rights have been violated by us, you may complain, in writing to Breathe Mind Body Therapy or to the Secretary of the Department of Health and Human Services at the address or website below. There will be no retaliation for filing a complaint. U.S. Department of Health and Human Services Office for Civil Rights 200 Independence Ave., S.W., Washington, D.C. 20201, calling 1-877-696-6775, or www.hhs.gov/ocr/privacy/hipaa/complaints/

 

 

Reviewed and approved by Joni Evans, LCPC, LMFT June 16, 2020.