Protecting the privacy of your personal health information is an important part of the therapeutic process. Federal law requires that you receive this Notice describing how your health information may be used and disclosed, as well as your rights regarding that information.

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

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Our Responsibilities

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Interiority Wellness, LLC is required by law to:

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• Maintain the privacy of your protected health information (PHI)

• Provide you with this Notice of our legal duties and privacy practices

• Abide by the terms of this Notice currently in effect

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You may request a copy of this Notice at any time.
For additional information regarding our privacy practices, please contact:

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Janet Nash, LISW-S
Interiority Wellness, LLC
(513) 676-0955

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Use and Disclosure of Protected Health Information

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For Treatment

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Your health information may be used and disclosed within Interiority Wellness, LLC for purposes related to your treatment. If coordination of care with another health care provider is necessary, your written authorization will be obtained prior to releasing any information.

 

For Payment

 

Your health information may be used or disclosed in order to obtain payment for services provided. For example, your insurance provider may require certain information to determine eligibility for benefits or to reimburse services. Only the minimum necessary information will be disclosed.

 

For Appointment Scheduling

 

Interiority Wellness, LLC may contact you by phone or leave messages regarding appointment scheduling or reminders.

 

Disclosures Without Your Authorization

 

Under Ohio and federal law, your protected health information may be disclosed without your consent in the following circumstances:

• Emergency Situations: Information may be shared to address an immediate health or safety emergency.

• Judicial or Administrative Proceedings: Information may be disclosed in response to a valid court order or other lawful legal process.

• Public Health Activities: Information may be disclosed if there is reason to believe you pose a serious risk to yourself or others.

• Abuse or Neglect: Information may be disclosed when there is suspicion of child or elder abuse or neglect.

• Criminal Activity or Threats: Information may be disclosed if a crime occurs on the premises or there is a serious threat of harm.

• Health Oversight Activities: Information may be disclosed for legally authorized audits, investigations, or inspections by regulatory agencies.

• National Security or Protective Services: Information may be released to authorized federal officials as required by law.

 

Only the minimum necessary information will be disclosed in these instances.

 

Your Rights Regarding Your Health Information

 

You have the right to:​

• Inspect and Copy: Request access to or copies of your health information (requests must be made in writing; reasonable fees may apply).

• Amend: Request changes to your health information in writing, with an explanation of why the amendment is needed.

• Request Restrictions: Ask that certain health information not be used or disclosed (for example, to an insurance company). You may be responsible for full payment of services if insurance billing is restricted.

• Request Confidential Communications: Request that we contact you in a specific way or at a certain location (for example, by mail or at work).

• Obtain a Paper Copy: Request a printed copy of this Notice at any time.

 

Authorization

 

Any uses or disclosures of your health information not described above will be made only with your written authorization. You may revoke this authorization at any time in writing, except to the extent that action has already been taken in reliance on it.

 

Changes to This Notice

 

Interiority Wellness, LLC reserves the right to revise privacy practices as permitted by law. Any revised Notice will be made available upon request.

 

Questions or Complaints

 

If you believe your privacy rights have been violated, you may file a complaint with:

• Interiority Wellness, LLC
  or

• The U.S. Department of Health and Human Services

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You will not be penalized or retaliated against for filing a complaint.