This Notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

The Health Insurance Portability & Accountability Act of 1996 (HIPAA), requires all health care records and other individually identifiable health information (protected health information or PHI) used or disclosed to us in any form, whether electronically, on paper, or orally, be kept confidential. The federal law gives you, the patient, significant rights to understand and control how health information is used.

 

I. My Pledge Regarding Health Information

I understand that health information about you and your health care is personal. I am committed to protecting health information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you and describe certain obligations I have regarding the use and disclosure of your health information.

I am required by law to:

• Make sure that protected health information (PHI) that identifies you is kept private.

• Give you this notice of my legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

 

II. How I May Use and Disclose Health Information About You

The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.

For Treatment, Payment, or Health Care Operations: I may use or disclose your PHI without your written authorization for treatment, payment, or health care operations. For example, I may disclose your information to another health care provider for diagnosis or treatment planning.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Other health care providers may require full access to ensure quality care.

Lawsuits and Disputes: If you are involved in a legal matter, I may disclose PHI in response to a court order or subpoena, with appropriate notice or protections.

 

III. Certain Uses and Disclosures Require Your Authorization

Session Notes: I keep session notes. Use or disclosure of these notes requires your written authorization unless:

• They are for my treatment of you.

• They are used for training or supervision.

• They are used to defend myself in legal proceedings.

• Required by law or health oversight activities.

• Required by a coroner.

• Necessary to avert a serious safety threat.

Marketing and Sale of PHI: I will not use or disclose your PHI for marketing purposes or sell your PHI in the course of business.

 

IV. Certain Uses and Disclosures Do Not Require Your Authorization

These may include:

• Reporting abuse or neglect

• Preventing or reducing serious threats to health or safety

• Health oversight and audits

• Judicial or administrative proceedings

• Law enforcement, national security, or presidential protective services

• Coroners or medical examiners

• Research under IRB protocols

• Workers’ compensation claims

• Appointment reminders or health-related services

• Business associates who perform services on my behalf (under binding legal agreement to protect your PHI)

• Emergency or disaster relief disclosures when you are unable to consent, as allowed by law

 

V. Certain Uses and Disclosures Require You to Have the Opportunity to Object

I may provide your PHI to a family member, friend, or other person involved in your care unless you object. In emergencies or disaster situations, this may happen retroactively if necessary.

 

VI. Your Rights Regarding Your PHI

You have the right to:

• Request Limits on certain uses or disclosures (I may deny these if it would affect care)

• Restrict Disclosures if you pay out-of-pocket in full

• Request Confidential Communications to a specific address or method

• Access Your Records and receive copies within 30 days

• Receive an Accounting of certain disclosures over the past six years

• Request Corrections to your PHI (denials must be explained in writing)

• Receive Notification if a breach of your unsecured PHI occurs

• Receive a Paper or Electronic Copy of this notice at any time

 

VII. Contact Information

Privacy Officer: James Foote
Practice Name: Lumen Creative Therapy Services PLLC
Address: PO BOX 553, Asheville, NC 28802
Phone: 828-772-9328
Website: lumencreativeavl.com Email: james@lumencreativeavl.com

If you believe your privacy rights have been violated, you may file a complaint with me at the contact above, or with the U.S. Department of Health and Human Services:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
www.hhs.gov/ocr/privacy/hipaa/complaints
You will not be penalized for filing a complaint.