HIPAA Privacy Policy
HIPAA Notice of Privacy Practices
This notice describes how medical information about you may be used and disclosed by Peregrine WORx, LLC and how you can get access to this information. Please review it carefully.
I. MY PLEDGE REGARDING HEALTH INFORMATION:
I am committed to protecting the privacy of your medical information. I am required by law to maintain the confidentiality of your protected health information (PHI) and to provide you with this Notice of our legal duties and privacy practices with respect to your PHI. I understand that your health information is private and personal, and I am committed to safeguarding it. As part of my commitment, I create and maintain a record of the care and services you receive from me. This record is necessary for providing you with quality care and complying with legal requirements. This notice applies to all records of your care that are generated by my practice. It describes how I may use and disclose your health information, as well as your rights and my obligations related to your health information.
Please note that I may change the terms of this Notice from time to time. Any changes will apply to all health information that I have about you. I will make the updated Notice available upon request and on my website. As your healthcare provider, I am required by law to ensure that your protected health information is kept private, provide you with this Notice of my legal duties and privacy practices, and follow the terms of the Notice that is currently in effect.
II. HOW I MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:
The following categories describe different ways that I use and disclose health information. For each category of uses or disclosures, I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways I am permitted to use and disclose information will fall within one of the categories.
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Treatment: I may use and disclose your medical information to provide, coordinate, or manage your healthcare and related services. This includes sharing information with healthcare providers involved in your care. Disclosures for treatment purposes are not limited to the minimum necessary standard because other healthcare providers need access to the full record and/or full and complete information in order to provide quality care. The word “treatment” includes, among other things, the coordination and management of healthcare providers with a third party, consultations between healthcare providers, and referrals of a patient for healthcare from one healthcare provider to another.
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Payment & Healthcare Operations: Federal privacy rules allow healthcare providers who have a direct treatment relationship with the patient/client to use or disclose the patient/client’s personal health information without the patient’s written authorization, to carry out the healthcare provider’s own treatment, payment or healthcare operations. For example, if a healthcare provider consults with another licensed healthcare provider about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, to assist the healthcare provider in the diagnosis and treatment of your condition. I may use and disclose your medical information to obtain payment for healthcare services provided to you. This includes sharing information with your health plan or insurance company. I may use and disclose your medical information for our healthcare operations, which include activities such as quality assessment and improvement, reviewing the competence or qualifications of healthcare professionals, and conducting business management and planning.
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As Required by Law: We may use and disclose your medical information when required by law, such as for public health purposes or in response to a court order. If you are involved in a lawsuit, I may disclose health information in response to a court or administrative order. I may also disclose health information about your child in response to a subpoena, discovery request, or other lawful processes by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Authorization: We will obtain your written authorization before using or disclosing your medical information for purposes other than those listed above.
III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:
Certain uses and disclosures of your health information require your authorization. This includes uses and disclosures for marketing purposes, the sale of your health information, and most uses and disclosures of psychotherapy notes. Additionally, I will obtain your written authorization before using or disclosing your health information for any purpose not covered by this notice or as otherwise required by law. If you provide me with authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, I will no longer use or disclose your health information for the reasons covered by your written authorization, except to the extent that I have already taken action based on the authorization.
Session Notes: I keep session notes that document our meetings, and any use or disclosure of such notes requires your authorization unless the use or disclosure falls within one of the following exceptions:
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For my use in providing you with treatment.
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For my use in training or supervising associates to help them improve their clinical skills.
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For my use in defending myself in legal proceedings instituted by you.
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For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
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Required by law and the use or disclosure is limited to the requirements of such law.
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Required by law for certain health oversight activities pertaining to the originator of the session notes.
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Required by a coroner who is performing duties authorized by law.
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Required to help avert a serious threat to the health and safety of others.
Marketing Purposes: I will not use or disclose your PHI for marketing purposes without your written authorization.
Sale of PHI: I will not sell your PHI in the regular course of my business without your written authorization.
IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION.
Subject to certain limitations in the law, I may use and disclose your PHI without your authorization for the following purposes:
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When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
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For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
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For health oversight activities, including audits and investigations.
For judicial and administrative proceedings, including responding to a court or administrative order. However, I will make reasonable efforts to obtain authorization from you before disclosing your PHI.
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For law enforcement purposes, including reporting crimes occurring on my premises.
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To coroners or medical examiners, when such individuals are performing duties authorized by law.
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For research purposes, including studying and comparing the patients who received one form of care versus those who received another form of care for the same condition.
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Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or, helping to ensure the safety of those working within or housed in correctional institutions.
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For workers’ compensation purposes: Although my preference is to obtain authorization from you, I may provide your PHI in order to comply with workers’ compensation laws.
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Appointment reminders and health-related benefits or services: I may use and disclose your PHI to contact you to remind you of an appointment with me. Additionally, I may use and disclose your PHI to inform you of available treatment alternatives, or other healthcare services or benefits that I offer.
V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT.
Disclosures to family, friends, or others: I may disclose your PHI to a family member, friend, or other person that you have designated as involved in your care or payment for healthcare, unless you object in whole or in part. In emergency situations, where you are incapacitated or otherwise unable to object, I may provide your PHI to a family member, friend, or other person involved in your care. I will make reasonable efforts to obtain your consent for such disclosures as soon as reasonably possible after the emergency situation has passed.
VI. YOU HAVE THE FOLLOWING RIGHTS WITH RESPECT TO YOUR PHI:
The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask me not to use or disclose certain PHI for treatment, payment, or healthcare operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your healthcare.
The Right to Request Restrictions for Out-of-Pocket Expenses Paid In Full: You have the right to request restrictions on disclosures of your PHI to health plans for payment or healthcare operations purposes if the PHI pertains solely to a healthcare item or a healthcare service that you have paid for out-of-pocket in full.
The Right to Choose How I Send PHI to You: You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
The Right to See and Get Copies of Your PHI: Other than “session notes,” you have the right to get an electronic or paper copy of your medical record and other information that I have about you. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and I may charge a reasonable, cost-based fee for doing so.
The Right to Get a List of the Disclosures I Have Made: You have the right to request a list of instances in which I have disclosed your PHI for purposes other than treatment, payment, or healthcare operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a reasonable cost-based fee for each additional request.
The Right to Correct or Update Your PHI: If you believe that there is a mistake in your PHI, or that a piece of important information is missing from your PHI, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
The Right to Get a Paper or Electronic Copy of this Notice: You have the right to get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.
Right to Access: You have the right to inspect and obtain a copy of your medical information.
Right to Amend: You have the right to request that we amend your medical information if you believe it is incorrect or incomplete.
Right to Request Restrictions: You have the right to request restrictions on how we use and disclose your medical information.
Right to Request Confidential Communications: You have the right to request that we communicate with you about your medical information in a certain way or at a certain location.
Right to File a Complaint: If you believe your privacy rights have been violated, you have the right to file a complaint with us or with the Secretary of the Department of Health and Human Services. Please inform us of any perceived violation before proceeding to file any complaint.
CONTACT INFORMATION
If you have any questions about this Notice or how we may use and disclose your medical information, please contact us at: 770-501-2001 by phone or info@peregrineworx.com by email.
EFFECTIVE DATE OF THIS NOTICE
This Notice is effective as of March 1, 2023. We reserve the right to revise or amend this Notice at any time. Any revision or amendment to this Notice will be effective for all of your medical information that we maintain at that time.