THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This clinic is required by law to provide you with this Notice of Privacy Practices (hereafter: "Notice") so that you will understand how we may use or share your information for your Designated Record Set. The Designated Record Set includes financial and health information referred to in this Notice as "Protected Health Information" ("PHI") or simply "health information". We are required to adhere to the terms outlined in this Notice. If you have any questions about this Notice, please contact our HIPAA Compliance Officer. 

UNDERSTANDING YOUR HEALTH RECORD AND INFORMATION

Each time you are seen at our clinic, a record of your visit is made containing health and financial information. Typically, this record contains information about your condition, the treatment we provide and payment for the treatment. We may use and/or disclose this information to: 

  • plan your care and treatment

  • communicate with your other health professionals involving your care

  • document the care you receive

  • educate health professionals

  • provide information for medical research

  • provide information to public health officials

  • evaluate and improve the care we provide

  • obtain payment for the care we provide

Understanding what is in your record and how your health information is used helps you to:

  • ensure it is accurate 

  • better understand who may access your health information

  • make more informed decisions when authorizing disclosure to others

HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU

The following categories describe the ways that we use and disclose health information. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall into one of the categories.

For Treatment

We may use or disclose health information about you to provide you with medical treatment. We may disclose health information about you to clinic personnel who are involved in taking care of you at our clinic. We may also share health information about you in order to coordinate your care. We may also disclose health information about you to people outside the clinic who may be involved in your care after you leave the clinic. This may include family members, or visiting nurses to provide care in your home. 

For Payment

We may use and disclose health information about you so that the treatment and services you receive at the clinic may be billed to you, an insurance or a third party. For example, in order to be paid, we may need to share information with your health plan about services provided to you. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

Methods 901 Health & Wellness and its affiliates or agents may communicate with you or your agent

We may use an automated telephone dialing system, pre-recorded messages and/or texting, to contact the cellular telephone number(s) that have been provided for appointment, payment, and collection purposes. It is the patients responsibility to provide the clinic with the most up to date information.

OTHER ALLOWABLE USES OF YOUR HEALTH INFORMATION

Business Associates 

There may be some services provided in our clinic through contracts with business associates. When these services are contracted, we may disclose your health information so that they can perform the job we've asked them to do and bill you or you third- party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

 

Health-Related Benefits and Services and Reminders

We may contact you to provide appointment reminders or other health related benefits and services that may be of interest to you.  

As Required By Law

We will disclose health information about you when required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety

We may use and disclose health information about you to prevent serious threat to your health and safety or the health and safety of the public or another person. We would do this only to help prevent the threat.

Organ and Tissue Donation

If you are an organ donor, we may disclose health information to organizations that handle organ procurement to facilitate donation and transplantation.

Military or Veterans

If you are a member of the armed forces, we may disclose health information about you as required by military authorities.

OTHER DISCLOSURES 

Reporting Federal and state laws may require or permit the clinic to disclose certain health information related to the following:

Public Health Risks

We may disclose health information about you for public health purposes, including:

  • Prevention or control of disease, injury or disability 

  • Reporting of child abuse or neglect

  • Reporting reactions to medications or problems with products

  • Notifying people of recalls of products

  • Notifying the appropriate government authority if we believe a resident has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law. ​

Health Oversight Activities

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 civil right laws.

Judicial and Administrative Proceedings

If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process 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.

Reporting Abuse, Neglect or Domestic Violence

Notifying the appropriate government agency if we believe a resident has been a victim of abuse, neglect or domestic violence.

Law Enforcement

We may disclose health information when requested by a law enforcement official:

  • In response to a court order, subpoena, warrant, summons or similar process;

  • To identify or locate a suspect, fugitive, material witness, or missing person;

  • About you, the victim of a crime if, under certain limited circumstances, we are unable to obtain your agreement;

Coroners, Medical Examiners and Funeral Directors

We may disclose medical information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also disclose medical information to funeral directors as necessary to carry out their duties.

Correctional Institution

Should you be an inmate of a correctional institution, we may disclose to the institution or its agents health information necessary for your health and the health and safety of others.

OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care we provided to you. 

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU

Although your health record is the property of the clinic the information belongs to you. You have the following rights regarding your health information:

Right to Inspect and Copy

With some exceptions, you have the right to review and copy your health information. You must submit your request in writing our HIPAA Compliance Officer. We may charge a fee for the costs of copying, mailing or other supplies associated with your request.

Right to Amend

If you feel that health information in your record is incorrect or incomplete, you may ask us to amend the information. You have the right for as long as the information is kept by or for the facility. You must submit your request in writing to our HIPAA Compliance Officer. In addition, you must provide a reason for your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment ;

  • Is not part of the health information kept by or for the clinic; or

  • Is accurate and complete

Right to an Accounting of Disclosures

You have the right to request an "accounting of disclosures". This is a list of certain disclosures we made of your health information, other than those made for purposes such as treatment, payment, or health care operations. 

You must submit your request in writing to our HIPAA Compliance Officer. Your request must state a time period which may not be longer than six years from the date the request is submitted and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a twelve month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

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 may request that we limit the health information we disclose to someone who is involved in your care or the payment of your care. You could ask that we not use or disclose information about a surgery you had to a family member or friend.

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. You must submit your request in writing to our HIPAA Compliance Officer.

In your request you must tell us:

  1. What information you want to limit​

  2. Whether you want to limit our use, disclosure or both

  3. To whom you want the limits to apply, for example, disvlosures to your spouse.

Right to Request Alternate Communications

You have the right to request that we communicate with you about medical matters in a confidential manner or a specific location. For example, you may ask that we only contact you via mail to post office box. You must submit your request in writing to our HIPAA Compliance Officer. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.

Right to a Paper Copy of this Notice

You have the right to a paper copy of this Notice of Privacy Practices even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time.
 

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. We reserve the right to make revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the facility and on the website. The Notice will specify the effective date for the revisions and copies can be obtained by contacting the clinic.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the clinic or with the Secretary of the Department of Health and Human Services. To file a complaint with the clinic, contact our HIPAA Compliance Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

CONTACT US

If you wish to contact us regarding the terms in this Notice, please contact:

Penney Williams or Polly Scholze

Phone Number: 901-308-1067

Email: penneywilliams7@gmail.com or pollyscholze@gmail.com

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901-308-1067
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Monday - Thursday   8:00 am - 5:00 pm

Friday                          8:00 am- 2:00 pm
Saturday                     Closed
Sunday                        Closed