NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
NOVUS Mindful Life Institute (“NOVUS”) is committed to providing you with quality services. NOVUS respects your privacy, and we understand that your personal health information is very sensitive. We are dedicated to protecting the confidentiality and security of your information. This Notice will tell you about the ways NOVUS may use and disclose health information that identifies you. We also describe your rights and our legal obligations under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regarding the use and disclosure of your personal health information.
Protected Health Information (“Health Information”). We are required by law to protect the privacy of the Health Information we create and obtain in providing care and services to you. Your protected health information includes your health history, symptoms, assessment results, diagnoses, treatment plan, progress notes, health information from other providers, and billing and payment information relating to these services. We will not use or disclose your Health Information to others without your authorization, except as described in this Notice or as required by law.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Although the health and billing records we create and store are the physical property of NOVUS Mindful Life Institute, the protected health information in it generally belongs to you. You have the following rights with regard to this information:
Right to Inspect and Copy. You have the right to inspect and copy your Health Information. Your request to inspect or review your Health Information must be submitted in writing. This right is not absolute as we are permitted to refuse access in some situations (e.g., if we determine that disclosure would be detrimental to you). However, we must explain our reasons. We also must inform you of your right to designate another licensed professional to review the records. If you request copies, we will charge you a reasonable fee to cover the costs of copying, mailing, supplies, and other expenses associated with your request. To the extent your information is held in an electronic health record, you may be able to receive the information in an electronic format. We may provide you with a summary of this information rather than providing access to your record, but only if you agree in advance.
Right to Amend. If you believe that information within your records is incorrect or incomplete, you have the right to request that we amend the information. The addendum can be no longer than 250 words per alleged incomplete or inaccurate information. Your request must be submitted in writing to the Privacy Officer listed at the end of this Notice. You will receive a response within 30 days of our receipt of the request. We may deny your request to amend your Health Information under the following conditions: (a) We did not create the record; (b) The records are unavailable for disclosure, or (c) The record is accurate and complete. If we deny your request, we will notify you why. If you disagree with the refusal, then you have the right to request a review of the decision by the Clinical Director and Privacy Officer. If we still decline to amend after review, you have the right to file a statement of disagreement for inclusion in any future disclosures of the disputed information. If we grant your request, we will make the change and must include the addendum whenever a disclosure of the allegedly incorrect or incomplete portion of your record is made.
Right to Confidential Communications. You have the right to receive confidential communications containing your Health Information by another confidential means of communication or at an alternate location. For example, you may ask that we only contact you by email or at your place of employment. We will grant your request given that we are able to do so without undue inconvenience. Your request for restrictions must be submitted in writing.
Right to Revoke Your Authorization. You have the right to submit a written request to revoke your consent or authorization to use or disclose Health Information, except to the extent that we have already taken action in reliance on the consent or authorization.
Right to Request Restrictions. You have the right to ask that we not use or disclose your Health Information in a particular way except when specifically authorized by you, when required by law, or during emergency circumstances. Although we will consider your request, we are not legally obligated to agree to those restrictions. You do not have the right to limit the uses and disclosures that we are legally required or permitted to use. Your request for restrictions must be submitted in writing. You also have the right to request that we not disclose Health Information to your insurer if that information relates to services for which you have paid out of pocket, in full, at the time of service. You must notify NOVUS of your request to not provide Health Information about the services to your insurer. We will agree to such requests unless required by law to disclose that information to the insurer.
Right to an Accounting of Disclosures. You have the right to receive an accounting of certain, non-routine disclosures of your Health Information over the past six years. The accounting will not include disclosures that were made (a) for purposes of treatment, payment, or health care operations; (b) to you; (c) pursuant to your authorization; (d) to your friends or family in your presence or because of an emergency; (e) for national security purposes; (f) to correctional institutions or law enforcement officials; or (g) incidental to otherwise permissible disclosures. Your request must be submitted in writing to the Privacy Officer listed at the end of this Notice. We must provide the accounting within 60 days. The accounting will include the date of each disclosure, the name and address of the organization or person who received the Health Information, a brief description of the disclosed information, and the reason for the disclosure. You may receive this information without charge once every 12 months. We will notify you of the cost involved if you request this information more than once in a 12-month period.
Right to be Notified of a Breach. You have the right to be notified in the event that we (or one of our Business Associates) discover a breach that may have compromised the privacy and security of your Health Information. Notice of any such breach will be made in accordance with federal requirements.
Right to a Paper Copy of this Notice. You have the right to obtain a hard copy of this Notice upon request, even if you have received the Notice electronically. You may request a copy at any time.
We are required by law to maintain the privacy of your Health Information, provide you with this Notice about our legal duties and privacy practices with respect to your Health Information, abide by the terms of the Notice currently in effect, train our staff concerning privacy and confidentiality, implement a sanction to discipline those who breach privacy/confidentiality, and notify affected individuals following a breach of unsecured Health Information. This Notice applies to all NOVUS personnel, including therapists and other clinical members of the NOVUS treatment team, administration, and other support staff. We will not use or disclose your Health Information without your authorization, except as described in this Notice or otherwise required by law. This includes most uses or disclosures of psychotherapy notes, marketing communications, and sales of Health Information.
OUR USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
There are many different reasons we may use and disclose your Health Information. As permitted or required by law, we may use and disclose your Health Information for certain purposes without your authorization. This section describes the different ways we can use and disclose your Health Information without your permission. Not every disclosure will be listed. However, all of the ways we are permitted to use and disclose Health Information will fall within one of the following categories.
For Treatment. We may use and disclose your Health Information with other professionals who are involved in your care for the purpose of providing, coordinating, or managing your treatment and related services. This includes consultation with clinical supervisors or other treatment team members. We may also provide information to health care providers outside our practice who have the medical or psychological responsibility for providing you care.
For Payment. We may use and disclose your Health Information so that we can bill and seek payment from you, the person financially responsible for your account, and/or your insurer for services you receive at NOVUS. Information provided to insurers may include your diagnoses, services rendered, or treatment recommendations. Your insurer may request your medical records to determine your care was necessary. Disclosure is limited to the minimal information necessary to allow responsibility for payment to be determined and made.
For Health Care Operations. We may use and disclose your Health Information to support our business activities, including, but not limited to, evaluation of treatment quality and improvement of our services, staff performance evaluations and training, resolution of internal grievances, and licensing. We may use your information to arrange or conduct other services, such as risk management, insurance services, and audit functions, including fraud and abuse detection and compliance programs.
Business Associates. We may provide some services through contracts with entities known as Business Associates who perform functions on our behalf or provide us with services. When we use these services, we may share your Health Information if it is necessary for them to perform the function(s) for which we have contracted with them. For example, we may share your Health Information with third parties that perform various business activities (e.g., accounting, billing, or legal services). To protect your Health Information, we require our business associates to appropriately safeguard the privacy of your Health Information, and they are not allowed to use or disclose any information other than as specified in their contract. They are required by law to comply with the same federal security and privacy rules as NOVUS.
Appointment Reminders, Treatment Alternatives, Health-Related Benefits, and Services. We may contact you to remind you that you have an appointment for treatment, to provide you information about possible treatment options or other alternatives, or to inform you of health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. We may share Health Information with a family member, a personal representative, or another person that you identify relevant to that person’s involvement in your care or payment related to your care. We may notify a family member, a personal representative, or another person responsible for your care, about your location or general condition, or disclose such information to an entity assisting during a disaster relief effort.
Medical Emergencies. We may disclose your Health Information to medical personnel who need the information to treat a condition which poses an immediate threat to your health and which requires immediate medical intervention. This includes situations in which you may need emergency treatment but are unable to express yourself (e.g., if you are unconscious or in severe pain).
As Otherwise Permitted or Required by Law. We may disclose your Health Information when required to comply by federal, state, or local law; judicial, board, or administrative proceedings; or law enforcement. We have to meet certain conditions set by law before we can share your information for these purposes, however.
Public Health and Safety. As required by law, we may use and disclose your Health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. We may disclose your Health information if necessary to prevent or reduce a serious and imminent threat to your health and safety or the health and safety of the public or another person. If the information is disclosed to prevent or reduce a serious threat, it will be disclosed to an individual reasonably able to prevent or reduce the threat, including the target of the threat.
As authorized by law, these activities also include disclosures to report: (a) child abuse (as mandated by the California Child Abuse and Neglect Reporting Act); (b) elder/adult dependent abuse (as mandated by the Report of Suspected Dependent Adult/Elder Abuse under the California Welfare & Institutions Code); or (c) the intentional viewing or exchange of pornography (in any form) that involves a minor under the age of 18 (as mandated by Assembly Bill 1775 under the California Child Abuse and Neglect Reporting Act).
Other public health and safety activities generally include disclosures of Health Information: (a) for purposes related to the quality, safety, or effectiveness of a product or activity regulated by the Food and Drug Administration; (b) to prevent or control disease, injury, or disability; (c) to report births and deaths; (d) to report reactions to medications or problems with products; (e) to notify people of product recalls; or (f) to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
Health Oversight. We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with applicable regulations.
Workers Compensation. We may disclose Health Information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Judicial and Administrative Proceedings. We may disclose your Health Information if compelled by a court, pursuant to an order of the court, subpoena, administrative order, or similar lawful process, when required by law.
Law Enforcement. We may disclose Health Information to a law enforcement official for the following reasons: (a) in compliance with a court order, subpoena, warrant, summons, or similar document; (b) to identify or locate a suspect, fugitive, material witness, or missing person; (c) about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (d) about a death we believe may be the result of criminal conduct; (e) about criminal conduct on our premises; or (f) to report a crime in emergency circumstances.
Correctional Institution. If you are an inmate of a correctional institution or under the custody of law enforcement, we may disclose to correctional institutions or officials thereof Health Information as necessary to provide you with care, to protect your health or the health and safety of others, or to protect the safety and security of the correctional institution.
Coroners, Medical Examiners, and Funeral Directors. We may disclose Health Information to a coroner, medical examiner, or funeral director consistent with applicable law to enable them to carry out their duties.
Military Personnel. If you are a member of the Armed Forces, we may release Health Information as required by appropriate military command authorities of U. S. and foreign military personnel.
Specialized Government Functions. We may release Health Information to authorized federal officials for national intelligence, counter-intelligence, and other national security activities authorized by law. We also may disclose Health Information to authorized federal officials so they may conduct special investigations and provide protection to the President, other authorized persons, and foreign heads of state.
Research. We may disclose information to researchers when the research has been reviewed by an institutional review board and protocols have been established to ensure the privacy of your Health Information.
OTHER USES OF YOUR HEALTH INFORMATION
Other uses and disclosures of your Health Information not covered by this Notice or applicable law will be made only with your written authorization with specific instructions and limitations on our use and disclosure of your Health Information. For example, except for limited circumstances allowed by federal privacy law, this includes the use or disclosure of psychotherapy notes, records for treatment of HIV and sexually transmitted diseases, and information about substance abuse treatment. Subject to some limited exceptions, your written authorization is also required for the sale of Health Information and for the use or disclosure of Health Information for most marketing purposes.
Once you give us the authorization to release your Health Information, we cannot guarantee that the recipient to whom the information is provided will not disclose the information. You may revoke your authorization at any time to prevent any future uses or disclosures by submitting a written request to the Privacy Officer listed at the end of this Notice.
COMPLIANCE WITH STATE LAWS
When we use or disclose your Health Information as described in this Notice, or when you exercise your rights set forth in this Notice, we may apply California state laws and provisions (e.g., Confidentiality of Medical Information Act, Lanterman-Petris-Short Act, California Health and Safety Code) about the confidentiality of your Health Information in place of federal privacy regulations. We do this when California state laws provide you with greater rights or protection for your Health Information. When California state laws are not in conflict or if these laws do not offer you more stringent privacy requirements, we will continue to protect your privacy by applying the federal regulations.
CHANGES TO THE TERMS OF THIS NOTICE
We reserve the right to change the terms of this Notice at any time. We also reserve the right to make the revised or changed Notice effective for all Health Information we maintain. The revised notice will be available upon request, in our office, and on our website.
HOW TO EXERCISE YOUR RIGHTS
To exercise your rights described in this Notice, send your written request to the Privacy Officer listed at the end of this Notice. Alternatively, you may contact your therapist directly to exercise your right to inspect and copy your Health Information. To obtain a copy of our Notice, contact the Privacy Officer listed at the end of this Notice.
If you believe that your privacy has been violated, or if you disagree with a decision we made about access to your Health Information, you may contact the Privacy Officer listed at the end of this Notice.
You can also file a complaint with the U. S. Department of Health and Human Services—Office for Civil Rights (OCR) by writing to 200 Independence Avenue, S.W., Washington, DC. 20201; calling #877.696.6775; or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
We respect your right to file a complaint and will not retaliate or penalize you for filing a complaint with us or the OCR.
If you have questions, need more information, or want to report a concern about the handling of your Health Information, please contact NOVUS Mindful Life Institute, 6695 E. Pacific Coast Hwy, Suite 135, Long Beach, CA 90803. Phone #562.431.5100, x0 Email: danielle@NovusMindfulLife.com
EFFECTIVE DATE This Notice takes effect on November 1, 2017.