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. Please review it carefully.
Our duties
- We are required by law to keep your protected health information (PHI) private and secure.
- We will tell you promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described here unless you tell us we can in writing. You may change your mind at any time by telling us in writing.
How we may use and share your information
- Treatment. To provide and coordinate your care, including with other clinicians, your collaborating physician, pharmacies and labs.
- Payment. To bill and get paid by health plans or other payers.
- Health care operations. To run our practice, improve care and contact you when necessary.
- Business associates. With vendors who help us, such as our electronic health record, telehealth and billing services, under written agreements that protect your information.
Other uses and disclosures allowed or required by law
- To prevent a serious threat to your health or safety, or the health or safety of others.
- For public health and safety, such as reporting suspected abuse, neglect or domestic violence.
- For health oversight, such as audits and licensing reviews.
- In response to a court order, subpoena or other lawful process.
- To law enforcement, medical examiners, workers' compensation programs and government functions, as the law allows.
- When required by federal, state or local law, including reporting to Ohio's prescription monitoring program (OARRS).
Uses that require your written permission
- Most sharing of psychotherapy notes.
- Marketing purposes.
- Sale of your information.
- Any use not described in this notice.
Substance use disorder treatment records protected by 42 CFR Part 2 receive additional protections and are shared only as that law allows.
Your rights
- Get a copy of your health record, electronic or paper. We may charge a reasonable, cost-based fee.
- Ask us to correct information you think is incorrect or incomplete.
- Request confidential communications, such as contact at a different phone number or address.
- Ask us to limit what we use or share. If you pay for a service in full yourself, you can ask us not to share it with your health plan.
- Get a list of those with whom we have shared your information in the past six years, with some exceptions.
- Get a copy of this notice at any time.
- Choose someone to act for you, such as a legal guardian or person with medical power of attorney.
- File a complaint if you believe your rights have been violated (see below).
Complaints
You can complain to us using the contact information below, or to the U.S. Department of Health and Human Services Office for Civil Rights at 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-877-696-6775, or at www.hhs.gov/ocr/complaints. We will not retaliate against you for filing a complaint.
Changes to this notice
We may change this notice, and the changes will apply to all information we have about you. The new notice will be available on our website and on request.
Contact
Privacy Officer: Vicky Cherotich, APRN-CNP
Village Path Mental Wellness LLC
[practice email] · [practice phone]