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.
Allied Family Health, LLC (“Allied”) is committed to maintaining the privacy of your protected health information (PHI). Generally, PHI is health and nonpublic financial information that can reasonably be used to identify you and that we maintain in the normal course of business. PHI also includes your personally identifiable information that we may collect from you in connection with your treatment. This notice provides you with how Allied uses and discloses your PHI, your individual rights, and Allied’s legal duties with respect to PHI.
Uses and Disclosures
Allied can use or disclose your PHI without your authorization in the following circumstances:
Treatment. Allied can use your PHI to aid in your treatment. For example, one of our practitioners may consult with our other clinical personnel to make sure your treatment plan is being followed.
Payment. Allied can use or disclose your PHI for billing purposes. For example, our practitioners will share their treatment notes with our billing personnel to facilitate payment for your treatment.
Health Care Operations. Allied can use or disclose your PHI to run our business, improve your care, or contact you when necessary. For example, Allied may use your PHI to develop better policies and procedures.
Business Associates for treatment, payment, or health care operations. Allied’s use of PHI for treatment, payment, or health care operations may involve our disclosure of your PHI to certain other individuals or entities with which we have contracted to perform or provide certain services on our behalf (“Business Associates”). Allied may allow our Business Associates to create, receive, maintain or transmit your PHI on our behalf in order for the Business Associate to provide services to us, for the Business Associates’ management and operations, or for the Business Associate to fulfill their legal responsibilities.
Public Health and Safety. Allied can share your PHI to prevent imminent serious public health and safety issues, to report suspected abuse or neglect, or government healthcare oversight activities.
To Comply with the Law. Allied will share your PHI as required by law.
Work with a Funeral Director or Medical Examiner. Allied can share your PHI with a coroner, medical examiner, or funeral director to carry out their duties as required by law.
For Workers’ Compensation. Allied may disclose your PHI as permitted by workers’ compensation and similar laws.
Uses and Disclosures that Require your Consent
Allied will only release your PHI under the following circumstances only after receiving your authorization.
Psychotherapy Notes. Allied will not disclose psychotherapy notes without your authorization except in circumstances where your provider uses the notes for treatment, for our own internal training programs for our mental health practitioners, to defend ourselves in a legal action or proceeding brought by you, or other disclosures allowed by law.
Marketing. Allied will not disclose your PHI for marketing purposes without your authorization except for face-to-face communication between you and us or to provide a promotional gift of nominal value.
Sale. Allied will not sell your PHI without your authorization.
Other Uses and Disclosures. Other uses and disclosures not described in the notice will be made only with your written authorization. You may revoke your authorization, in writing, except to the extent that we have taken action in reliance thereon.
Individual Rights
This Section explains your rights regarding your PHI and information on how to exercise your rights.
Request Restrictions. You have the right to request that we limit our use and disclosure of PHI for treatment, payment, or health care operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
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 consider all reasonable requests.
Copy of Health Records. You have the right to inspect and obtain a copy of all of your PHI except in limited circumstances. We will provide a copy of your information, usually within 30 days from your request. We may charge a reasonable, cost-based fee.
Correct Records. You can ask us to correct your health records if you think they are incorrect or incomplete. You must send us this request in writing. We may deny your request, but we will tell you why in writing within 60 days.
Accounting of Disclosures. You can ask for a list of the times we have 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 will 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 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.
Our Duties
Allied’s responsibilities regarding your PHI include:
- We are required by law to maintain the privacy and security of your PHI
- 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 PHI other than as described herein unless you tell us we can in writing. If you tell us we can, you can change your mind at any time. Let us know in writing if you change your mind.
Complaints
If you feel that your rights have been violated you can make a complaint as provided in this Section. Rest assured, we will not retaliate against you for filing a complaint.
To make a complaint to the company, please contact Jeffrey Lampley, Chief Compliance Officer, 5237 Summerlin Commons Blvd., Ste. 215, Fort Myers, FL 33907, 239-275-2289.
To make a complaint with the U.S. Department of Health and Human Services Office for Civil Rights send a letter to 200 Independence Ave, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
Changes to the Terms of This Notice
Allied reserves the right to change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be provided upon request and we will provide you a copy at your next visit.