Reflections Wellness and Spa
402 Richmond Road, Suite B,
Berea, KY 40403
PHONE: 859-868-1058 | FAX:
vicky@reflectionswellnessandspa.com
NOTICE OF HIPAA PRIVACY PRACTICES
Per the Privacy Regulations required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (BDPC PATIENT) MAY BE USED AND DISCLOSED, INCLUDING HOW TO ACCESS YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. PLEASE REVIEW.
Vicky@reflectionswellnessandspa.com is considered HIPAA compliant but please minimize information to demographic information only shared via this email.
All forms will be completed via JaneApp.
All Billing and Payments will be conducted via Jane App and Clover.
Please find information for our Vendor's Privacy Policies and Protocols in the links below:
JaneApp https://jane.app/legal/privacy-policy
Clover https://www.clover.com/privacy-policy
Please see Terms & Conditions for info. This section tells you how your personal health Information is utilized and disclosed. All email, text, phone, and postal communication will maintain HIPAA compliance and be secured for the safety of your health information.
Please also see our Privacy Page
1. Reflections Wellness and Spa’s Commitment to Patient Privacy:
Our practice is dedicated to maintaining the privacy of your individually identifiable health information (IIHI) or Personal Health Information (PHI). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and the privacy practices that we maintain in our practice concerning your IIHI/PHI.
In this notice we will provide you with the following information:
The terms of this notice apply to all records containing your PHI that are created or retained by our practice. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.
Please communicate with us via phone, ____ and ____ This will allow us to help keep your health information secure.
2. Have Questions about our Privacy Policies?
Please contact us at the address/phone/email listed above. Our listed email is also HIPAA compliant and encrypted for added safety of your PHI.
3. It is possible that we will use or disclose your Personal Health Information (PHI) in the ways listed below:
You may object to the use or disclosure of your PHI for any of these purposes at any time.
Treatment
· Prescription writing and electronic prescriptions sent to a pharmacist securely
· Outsourced laboratory tests (blood work)
· Communication between Reflection’s nurses, medical staff in order to coordinate your care or assist others in your treatment.
· Disclosures to other healthcare providers, your spouse, your children or your parents in order to aid in your treatment.
Payment
· Billing to family members responsible for the cost of our services such as a parent/caregiver or other custodial relationship.
· Billing you directly for fees and services
Health Care Operations
Our practice may use and disclose your IIHI to operate our business in order to:
· Evaluate the quality of care you received from us
· Develop protocols, clinical guidelines, and training programs
· Aid in credentialing, medical review, legal services, and insurance.
Appointment Reminders
Our practice may use and disclose your PHI to contact you and remind you of an appointment. See Jane App policies
Treatment Options
Our practice may use and disclose your PHI to inform you of potential treatment options or alternatives.
Health-Related Benefits and Services
Our practice may use and disclose your PHI to inform you of health-related benefits or services that may be of interest to you.
Release of Information to Family/Friends
Our practice may release your PHI to a friend or family member that is involved or assists in your care. Ex. Babysitter, grandparent, family friend, hired caregiver that brings a patient to appointments or calls on their behalf.
Disclosures Required by Law
Our practice will use and disclose your PHI when we are required to do so by federal, state, or local law.
4. SPECIAL CIRCUMSTANCES for PHI Use and Disclosures:
The following categories describe unique scenarios in which we may use or disclose your identifiable health information:
Public Health Risks. Our practice may disclose your PHI to public health authorities that are authorized by law to collect information for the purpose of:
Health Oversight Activities
Our practice may disclose your PHI to a health oversight agency for activities authorized by law. For example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws, and the health care system in general.
Lawsuits and Legal Proceedings
Our practice may use and disclose your PHI in response to a court or administrative order if you are involved in a lawsuit or similar proceeding. This includes discovery requests, subpoenas, or other lawful processes by another party involved in the dispute, but only if we have made an effort to inform you of the request.
Law Enforcement
We may release IIHI if asked to do so by a law enforcement official:
· regarding a crime victim in certain situations, if we are unable to obtain the person’s consent
· concerning a death we believe has resulted from criminal conduct
· regarding criminal conduct at our offices
· in response to a warrant, summons, court order, subpoena, or similar legal process
· to identify/locate a suspect, material witness, fugitive or missing person
· in an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)
Deceased Patients
Our practice may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we may also release information in order for funeral directors to perform their jobs.
Organ and Tissue Donation
Our practice may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
Research
Our practice may use and disclose your PHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PHI for research purposes except when: (a) our use or disclosure was approved by an Institutional Review Board or a Privacy Board; (b) we obtain the oral or written agreement of a researcher that (i) the information being sought is necessary for the research study; (ii) the use or disclosure of your PHI is being used only for the research and (iii) the researcher will not remove any of your PHI from our practice; or (c) the PHI sought by the researcher only relates to decedents and the researcher agrees either orally or in writing that the use or disclosure is necessary for the research and, if we request it, to provide us with proof of death prior to access to the PHI of the decedents.
Serious Threats to Health or Safety. Our practice may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
Military
Our practice may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.
National Security. Our practice may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We may also disclose your PHI to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
Inmates
Our practice may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.
Workers’ Compensation
Our practice may release your PHI for workers’ compensation and similar programs.
5. Your Rights Regarding Your Personal Health Information:
The health and billing records we maintain are the physical property of Reflections Wellness and Spa.
The information in it, however, belongs to you. You have a right to:
Confidential Communications. You have the right to request that our practice communicates with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than at work. In order to request a type of confidential communication, you must make a written request to the Privacy Officer, specifying the requested method of contact, or the location where you wish to be contacted. Our practice will accommodate reasonable requests. You do not need to give a reason for your request.
Requesting Restrictions You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to the Privacy Officer email/physical address above.
Your request must describe in a clear and concise fashion:
· the information you wish restricted;
· whether you are requesting to limit our practice’s use, disclosure or both
· to whom you want the limits to apply
Inspection and Copies
You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to the Privacy Officer in order to inspect and/or obtain a copy of your PHI. Our practice may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed healthcare professional chosen by us will conduct reviews.
Amendment
You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our practice. To request an amendment, your request must be made in writing and submitted to the Privacy Officer. You must provide us with a reason that supports your request for amendment. Our practice will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for the practice; (c) not part of the PHI which you would be permitted to inspect and copy; or (d) not created by our practice, unless the individual or entity that created is not available to amend the information.
Accounting of Disclosures
All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your PHI for non-treatment or operations purposes. Use of your PHI as part of routine patient care in our practice is not required to be documented. For example, the doctor shares information with the nurse. In order to obtain an accounting of disclosures, you must submit your request in writing to the Privacy Officer. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but our practice may charge you for additional lists within the same 12-month period. Our practice will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
Right to a Paper Copy of this Notice
You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the Privacy Officer.
Right to File a Complaint
If you believe your privacy rights have been violated, you may file a complaint with our practice or with the Secretary of the Department of Health and Human Services.
To file a complaint with our practice, contact:
Reflections Wellness and Spa Attn: Privacy Officer, 402 Richmond Road, Suite B, Berea, Ky 40403
All complaints must be submitted in writing. You will not be penalized for filing a complaint.
Right to Provide an Authorization for Other Uses and Disclosures. Our practice will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note: we are required to retain records of your care.
Acknowledgement
I hereby acknowledge that I have received and read Bluegrass DPC HIPAA Privacy Policy Notice. I understand that I may request additional copies of this notice at any time.
Reflections Wellness and Spa
402 Richmond Rd. N, Suite B, Berea KY 40403
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