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.

 

The Health Insurance Portability and Accountability Act (HIPAA; “Act”) of 1996, revised in 2013, requires us as your health care provider to maintain the privacy of your protected health information, to provide you with notice of our legal duties and privacy practices with respect to protected health information, and to notify affected individuals following a breach of unsecured protected health information. We are required to maintain these records of your health care and to maintain confidentiality of these records. 

 

YOUR RIGHTS CONCERNING YOUR PROTECTED HEALTH INFORMATION

 

You Have the Right To:

• Get a copy of our paper or electronic medical record

  • You can ask to see or get an electronic or paper copy of your medical records and other health information we have about you. The request must be in writing, and we must verify your identity before allowing the requested access. Please ask us how to do this

  • We are required to allow the access or provide the copy within 30 days of your request. We may charge a reasonable, cost-based fee.

• Correct your paper or electronic medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Please ask us how to do this.

  • We may say “no” to your request, but we will tell you why in writing within 60 days.

• Request confidential communication

  • You can ask us to contact you in a specific way (for example, home, office or cell phones) or to send mail to a different address or email.

  • We will say “yes” to all reasonable requests.

• Ask us to limit the information we share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your heath insurer. We will say “yes” unless a law requires us to share that information.

• Get a list of those with whom we’ve shared your information

  • You can ask for a list (accounting)of the times we’ve 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 ask us to make). We’ll 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 privacy notice

  • You can ask for a paper copy of this notice at any time and it will be provided to you. A copy is also available on our website: www.j2therapy.com

• Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

• File a compliant if you believe your privacy rights have been violated

  • You can file a compliant if you feel J2 Therapy & Wellness has violated your rights by directly informing J2 Therapy & Wellness owners

  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visitingwww.hhs.gov/ocr/privacy/hipaa/complaints/.

 

DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION

We may use and share your information for treatment, payment, and certain health operations unless otherwise prohibited by law and without your authorization. 

• Treatment

  • We can use your health information and share it with other professionals, such as other therapists and/or physicians who are treating you, hospitals and diagnostic centers should you need to be admitted.

• Health Operations

  • We can use and share your health information to run our practice, improve your care, and contact you when necessary. This is necessary for the proper management of your treatment and services. In addition, your health information may be used to train new health care workers, to evaluate the health care delivered, to improve our business development, or for other internal needs.

• Payment and Billing

  • We can use and share your health information to bill and get payment from health plans or other entities.

• Help with Public Health and Safety Issues

  • We can share health information about you for certain situations such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.

• Do Research

  • We can use or share your information for health research

• Comply with the Law

  • We will share information about you if state or federal law requires it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

• Respond to Organ and Tissue Donation Requests

  • We can share health information about you with organ procurement organizations. 

• Work with a medical examiner or funeral director

  • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

• Address Workers’ Compensation, Law Enforcement, and other Government Requests

  • We can use or share health information about you for workman’s compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, for special government functions such as military/national security/presidential protective services.

• Respond to Lawsuits and Legal Actions

  • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

 

OUR RESPONSIBILITIES

• We are required by law to maintain the privacy and security of your protected health information.

• 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 upon request.

• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. You must let us know in writing if you change your mind.

 

 

For more information (provided in multiple languages): 

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Code of Federal Regulations: 

https://www.gpo.gov/fdsys/pkg/CFR-2003-title45-vol1/xml/CFR-2003-title45-vol1-sec164-506.xml

 

You have the right to file a complaint with us or with the Office for Civil Rights. We will not discriminate or retaliate in any way for this action. To file a complaint, please contact the applicable party:

Office for Civil Rights: http://www.hhs.gov/ocr/privacy/hipaa/complaints/index.html

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Or you may submit a written complaint to: Centralized Case Management Operations

U.S. Department of Health and Human Services

200 Independence Avenue, S.W

Room 509F HHH Bldg.

Washington, D.C. 20201

 

CHANGES TO THE TERMS OF THIS NOTICE

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.