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.
Your rights
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 a copy of your health and claims records
- You can ask to see or get a copy of your health and claims records 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 and claims records, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct health and claims records
- You can ask us to correct your health and claims records if you think they are 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 at the end 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.
Your Rights Regarding Your Substance Use Disorder Records
- Right to Request Restrictions: You have the right to request that we restrict how we use or disclose your SUD records for treatment, payment, or healthcare operations. If you pay for a treatment or service entirely out-of-pocket, you have the right to restrict disclosures of related SUD information to your health plan, and we must honor that request.
- Right to an Accounting of Disclosures: You have the right to receive a list (an accounting) of certain disclosures we have made of your health data. For SUD records shared through an electronic health record for treatment, payment, or healthcare operations, you have the right to request an accounting of these disclosures made over the past 3 years.
- Right to Revoke Consent: If you sign a consent form allowing us to share your SUD records, you have the right to revoke that consent at any time in writing, except to the extent that we have already taken action based on your previous permission.
Your choices
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.
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
Our uses and disclosures
Treat you
We can use your health information and share it with other professionals who are treating you. Example: A laboratory processes the tests ordered at your visit and returns the results to us.
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 your information to schedule visits and send appointment reminders.
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.
Other ways we can use or share your 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.
- Public health and safety: preventing disease, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
- Research: 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.
- Medical examiners or funeral directors: we can share health information with a coroner, medical examiner, or funeral director when an individual dies.
- Workers’ compensation, law enforcement, and other government requests: for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services.
- 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.
Special Protections for Substance Use Disorder Records
Some of the health records we create, receive, or maintain may be protected under federal confidentiality regulations for substance use disorder (SUD) patient records (42 CFR Part 2).
- Treatment, Payment, and Health Care Operations: If you provide your written consent, we may use and disclose your SUD records to coordinate your care, process billing and payments, and conduct healthcare quality reviews. Once you provide this consent, we may further share or redisclose these records as permitted by the HIPAA Privacy Rule, subject to the restrictions below.
- Use in Legal Proceedings: Your SUD records cannot be used or disclosed in any civil, criminal, administrative, or legislative investigations or legal proceedings against you unless you provide separate, explicit written consent, or unless a court issues a specific order and a subpoena compelling the disclosure. This means your records cannot be used as evidence in a criminal prosecution or a civil lawsuit against you without your permission or a judge's order.
- Other Permitted Disclosures: We may disclose your SUD records without your consent only in limited emergency situations to medical personnel, for authorized public health reporting (provided the data is de-identified), or for scientific research and audit purposes under strict privacy safeguards.
Substance use disorder records
The practice applies stricter confidentiality rules to Substance Use Disorder (SUD) patient records protected under 42 CFR Part 2, restricting their use in legal proceedings without explicit consent or a court order. Additionally, separate written authorization is required for marketing, fundraising, or data sales involving SUD records, and patients retain the right to revoke consent for sharing at any time in writing.
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 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.
Our Duties and Breach Notification
We are required by law to maintain the privacy and security of your protected health information. We are strictly bound by federal law to provide you with prompt notification if a data breach occurs that compromises the privacy, security, or confidentiality of your health data, including any unsecured substance use disorder patient records maintained by our practice.
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, in the patient portal, and on our website.
Contact
Privacy Officer: Olivia L. Young, PhD, PMHNP-BC
Mind Body Works Telehealth LLC · Missouri
Email: support@mindbodyworks.us · Phone: (314) 409-6123
This notice applies to Mind Body Works Telehealth LLC and Olivia L. Young, PhD, PMHNP-BC.