HIPAA NOTICE OF PRIVACY PRACTICES for protected health information.
EFFECTIVE DATE: Feb 3, 2020 [MODIFIED: Oct 2, 2021]
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
My Pledge Regarding Health Information (Español)
In this notice I use the terms "I," "Me," and "My" to describe Jessica Wrye, RDN, CDCES, owner of As You Are Nutrition and/or anyone employed by As You Are Nutrition. This may include other clinicians and office staff members.
Protected health information (“PHI”) means any information, whether oral or recorded in any form, that is created or received by me and relates to your past, present, or future physical or mental health, health care treatment, and payment for health care services. PHI includes demographic information such as your name, social security number, address, and date of birth and either identifies you as an individual or there is a reasonable basis to believe that the information could be used to identify you.
I understand that the information about you and your health care is personal and I am committed to protecting your PHI.
As part of your treatment, I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this practice. This notice will tell you about the ways in which I may use and disclose your PHI. This notice also describes your rights to your PHI and describes the obligations I have regarding the use and disclosure of your PHI.
I am required by law to:
Ensure that your PHI remains private and confidential;
Inform you of your rights and my legal duties and privacy practices with respect to PHI;
Comply with the terms of this Notice of Privacy Practices as currently in effect;
Notify you if there is a breach of your unsecured PHI; and
Provide you with notice if the material terms of my Privacy Practices change. While I am authorized to modify the terms of this Notice, if the material terms of this Notice are modified, I will send you the updated notice through your patient portal. The new notice will also be available upon request, in my office, and on the As You Are Nutrition website, asyouarenutrition.com.
How I May Use and Disclose Health Information About You
The following categories describe different ways that I may use and disclose health information. For each category of uses or disclosures I will explain what I mean and give an example. 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.
For treatment, payment, or health care operations: Federal privacy rules (regulations) allow health care providers who have a direct treatment relationship with the patient to use or disclose the patient’s personal health information without the patient’s written authorization, to carry out the health care provider’s own treatment, payment or health care operations.
1. Treatment: I may disclose your protected health information to effectuate your treatment plan without your written authorization. For example, if I were to consult with another of your licensed health care providers about your condition, we would be permitted to use and disclose your personal health information, which is otherwise confidential, in order to assist in the diagnosis and treatment of your condition.
2. Payment: I may disclose your protected health information to bill and get payment from health plans or other entities without your written authorization. For example, I will disclose your PHI to your insurance provider to request payment for your treatment.
3. Health Care Operations: I may disclose your protected health information in the course of business operations without your written authorization. For example, I may use your PHI to assess the quality of my office operations or I may disclose your PHI as part of an educational training program in which health care students or trainees learn under my supervision to practice or improve their skills.
Certain Uses & Disclosures Require Your Authorization
Uses and disclosures not described in this Notice will be made only with your written authorization and you have the right to revoke an authorization at any time. To revoke a previously given authorization, please contact my office by using the contact information at the top of this Notice and provide a written statement of your intent to revoke your authorization.
1. Session Notes: I keep notes to document what took place during group and individual treatment sessions and any use or disclosure of such notes requires your authorization unless the use or disclosure is: (a) for my use in treating you; (b) for my use in implementing training programs where students, trainees, or practitioners in mental health learn under my supervision to practice or improve their skills; (c) for my use in defending myself in legal proceedings brought by you; (d) for use by the Secretary of Health and Human Services to investigate my compliance with HIPAA; (e) as required by law and the use or disclosure is limited to the requirements of such law; (f) as required to help avert a serious threat to the health and safety of others; and (g) for the lawful activities of a medical examiner or coroner.
2. Marketing Purposes: As a health care provider, I will not use or disclose your PHI for marketing purposes.
3. Sale of PHI: As a health care provider, I will not sell your PHI in the regular course of my business.
Certain Uses & Disclosures Do Not Require You Authorization
Subject to certain limitations in the law, I am able to use and disclose your PHI without your authorization for the following reasons:
1. 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;
2. For public health activities, such as when patients have contracted or been exposed to a communicable disease when notification is authorized by law;
3. When there is a serious threat to health or safety. I may disclosure PHI to prevent or lessen a serious and imminent threat to a person or the public, when such disclosure is made to someone I believe can prevent or lessen the threat;
4. For health oversight activities, including audits and investigations necessary for the `oversight of the health care system;
5. For victims of abuse, neglect or domestic violence, there are situations where disclosure of PHI may be necessary;
6. For legal proceedings, including responding to a court order or administrative order response to a subpoena but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested;
7. For limited law enforcement purposes, including if I believe that protected health information is evidence of a crime that occurred on my premises;
8. To coroners or medical examiners, when they are performing duties authorized by law;
9. For research purposes, including studying patients who received one form of care versus those who received another form of care for the same condition;
10. For cadaveric organ, eye, or tissue donation, I may use or disclose PHI to facilitate the donation and transplantation of cadaveric organs, eyes, and tissue;
11. For specialized government functions, including, ensuring the proper execution of military missions, protecting the President of the United States, conducting intelligence or counterintelligence operations, and helping to ensure the safety of those working within or housed in correctional institutions;
12. For workers’ compensation purposes. I may disclose your PHI in order to comply with workers’ compensation laws such as disclosing your PHI to insurance providers or claims administrators to evaluate your claim for workers’ compensation benefits; and
13. For appointment reminders and health related benefits or services. I may use and disclose your PHI to contact you to remind you that you have an appointment with me. I may also use and disclose your PHI to tell you about treatment alternatives, or other health care services or benefits that I offer.
Inmates of a correctional institution or those in law enforcement custody do not have the same privacy rights and, if you are an inmate or in law enforcement custody, I may disclose your PHI to the correctional institution or the law enforcement official for certain purposes, for example, to protect your health or safety or someone else's.
Certain Uses & Disclosures Require You To Have The Opportunity To Object
1. Disclosures to family, friends, or others. I may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.
2. Disclosures for facility directories. I do not maintain a facility directory.
You Have The Following Rights With Respect To Your PHI
1. 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 health care operations purposes. I will agree to your request if the disclosure is for the purpose of carrying out payment or health care operations, if the disclosure is not otherwise required by law, and if the request pertains solely to a health care service that you have paid for out of pocket in full. If your request does not fall under this requirement, I am not required to agree to your request, and I may say “no” if I believe it would affect your health care.
2. The right to receive confidential communications. You have the right to ask me to contact you in a specific way. For example, you may request that I only contact you on your cell phone number or refrain from contacting you at your place of business and I will agree to all reasonable requests.
3. The right to see and get copies of your PHI. Other than the session notes that I described above, you have the right to get an electronic or paper copy of your medical records 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.
4. 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 health care 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.
5. The right to correct or update your PHI. If you believe that there is a mistake on 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 and to have your PHI corrected or updated within 60 days. Under limited circumstances, I may decline your request, but I will tell you why in writing within 60 days of receiving your request.
6. The right to get a paper or electronic copy of this Notice. You have the right to get a paper copy of this Notice at any time. Even if you agreed to receive this Notice by email or other electronic means, you still have the right to receive a paper copy of this Notice.
7. The Right to File a Complaint. You have the right to file a complaint with my office if you feel that your privacy rights have been violated. To file a complaint with my office, please provide your complaint in writing by using the following contact information:
Jessica Wrye, RDN, CDCES — As You Are Nutrition
1606 Main Street, Ste 210. Napa CA, 94559
Email: jessie@asyouarenutrition.com | Phone: (707) 200-1178
You have the right to file a complaint with the United States Department of Health and Human Services, Office for Civil Rights (“OCR”) if you feel that your privacy rights have been violated. If you need help filing a complaint you may email the OCR at OCRMail@hhs.gov or call the U.S. Department of Health and Human Services, Office for Civil Rights toll-free at: 1-800-368-1019, TDD: 1-800-537-7697. You are also able to file a complaint with the OCR through their online portal: (https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf)
If you feel that your privacy rights have been violated and you file a complaint either with my office or with the OCR, or both, you have a right not to be retaliated against for doing so.
To request a limit on the use or disclosure of your PHI, a copy of your medical records, a copy of thisPrivacy Notice, a list of the disclosures I have made, that a correction or update be made to your PHI, or to request a different method of communication with this office, please submit a written request using the following contact information:
Jessica Wrye, RDN, CDCES — As You Are Nutrition
1606 Main Street, Ste 210. Napa CA, 94559
Email: jessie@asyouarenutrition.com | Phone: (707) 200-1178