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.
This notice describes our policies related to the use of the records of your care at Interiority Wellness, LLC. We are required to give you this Notice about (1) the use and disclosure of your health information, (2) our legal responsibilities, and (3) your rights concerning your health information and to abide by the terms of this notice.
You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional information, contact Janet Nash, (513) 498-7850.
Use and Disclosure of Protected Health Information
For Treatment. We use and disclose your health information internally in the course of your treatment at Interiority Wellness, LLC. If we wish to provide information outside of Interiority Wellness, LLC for your treatment by another health care provider, we will have you sign an authorization for release of information.
For Payment. We may use and disclose your health information to obtain payment for services we provide to you. For example, we may need to give insurance companies or other agencies the minimum necessary information in order for them to pay us for the service we have provided to you.
For Health Care + Wellness Opportunities. We may use and disclose your health information to tell you about services, educational activities, and programs that we feel might be of interest to you under the Grace Tree Yoga & Growth Studio umbrella.
We use and disclose the minimum necessary health information about you for your treatment and for payment for your services.
Information Disclosed Without Your Consent
Under Ohio and federal law, information about you may be disclosed without your consent in the following circumstances.
Emergencies. Sufficient information may be shared to address an immediate emergency you are facing.
Judicial and Administrative Proceedings. We may disclose your personal health information in the course of a judicial or administrative proceeding in response to a valid court order or other lawful process, including if you were to make a claim for Workers Compensation.
Public Health Activities. If we felt you were an immediate danger to yourself or others, we may disclose health information about you to the authorities, as well as alert any other person who may be in danger.
Child/Elder Abuse. We may disclose health information about you related to the suspicion of child and/or elder abuse or neglect.
Criminal Activity or Danger to Others. We may disclose health information if a crime is committed on our premises or against our personnel, or if we believe there is someone who is in immediate danger.
National Security, Intelligence Activities, and Protective Services to the President and Others.We may release health information about you to authorized federal officials as authorized by law in order to protect the President or other national or international figures, or in cases of national security.
Health Oversight Activities. We may disclose health information to a health oversight agency for activities authorized by law. These activities might include audits or inspections and are necessary for the government to monitor the health care system and assure compliance with civil rights laws. Regulatory and accrediting organizations may review your case record to ensure compliance with their requirements. The minimum necessary information will be provided in these instances.
Marketing. Interiority Wellness, LLC may send you newsletters or information about services we provide in which we feel you might be interested. You may at any time request that your name be removed from our mailing list. We will not disclose any information to a third party for their use in telemarketing, direct mail marketing, or marketing through electronic mail.
Scheduling Appointments. Interiority Wellness, LLC may use your phone number to call you and leave messages to schedule or remind you of appointments.
Your Rights Regarding Your Health Information:
Right to Inspect and Copy. You have the right to look at or get copies of your health information, with limited exceptions. Your request must be in writing. If you request a copy of the information, a reasonable charge may be made for the costs incurred.
Right to Amend. You have the right to request that we amend your health information. Your request must be in writing, and it must explain why the information should be amended. We have the right to deny your request under certain circumstances.
Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you. For example, you could ask that we not share information with an insurance company, in which case you would be responsible to pay in full for the services provided. While you are in treatment, a written request should be made with your therapist. We are not required to agree to your request, but we will consider the request very seriously. If we agree, we will abide by our agreement unless the information is needed in an emergency or by law.
Right to Request Confidential Communications. You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you may ask that we contact you only by mail or at work. You must make this request in writing and it must specify the alternative means or location that you would like us to use to provide you information about your health care. We will make every attempt to accommodate reasonable requests.
Right to Obtain a Paper Copy of this Notice. You have the right to receive a paper copy of this notice and any amended notice upon request. Copies will be available upon request.
Any other uses and disclosures not set out in the information above will be made only with your written authorization. You may revoke a written authorization for release of information at any time. The revocation must be in writing and will become effective when it has been received by the Interiority Wellness, LLC, and will only be for disclosures not already completed.
We reserve the right to change our privacy practices provided such changes are permitted by applicable law. Before the effective date of a material change, however, we will change this Notice and make a new Notice available to you upon request.
Questions and Complaints
If you believe your privacy rights have been violated, you may file a complaint with us, or you may file a complaint with the U. S. Department of Health & Human Services. We will not retaliate in any way if you choose to file a complaint.
This Notice is effective 4/4/2019