BALANCED BODY AND MIND OT, LLC (“BALANCED BODY AND MIND OT”)
NOTICE OF PRIVACY PRACTICES
This Notice is effective as of May 5, 2023.
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.
This notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) may use or disclose your protected health information, with whom that information will be shared, and the safeguards Balanced Body and Mind OT have in place to protect it. This notice also describes your rights to access and refuse the release of specific information outside of this system except when the release is required or authorized by law or regulation.
Balanced Body and Mind OT is required to maintain the privacy of Protected Health Information (“PHI”) and to provide individuals with notice of our legal duties and privacy practices with respect to PHI. PHI is information that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices (“Notice”) describes how we (therapists, office personnel, billing personnel, employees, officers, directors, contractors, business associates, volunteers, health care students, interns, residents, fellows, and affiliates) may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. The Notice also describes your rights with respect to PHI about you.
Acknowledgment of Receipt of this Notice
You will be asked to provide a signed acknowledgment of receipt of this notice. The intent is to make you aware of the possible uses and disclosures of your Protected Health Information (“PHI”) and your privacy rights.
Balanced Body and Mind OT is required to follow the terms of this Notice. We will not sell your name and address or other identifying information for any purpose. We will not use or disclose PHI about you without your written authorization, except as described in this Notice. We reserve the right to change our practices and this Notice and to make the new Notice effective for all PHI we maintain. Upon request, we will provide any revised Notice to you.
Who Will Follow this Notice
Balanced Body and Mind OT works with several agencies and referral sources. This notice applies to all therapy services provided by Balanced Body and Mind OT. It also applies to office and billing personnel, employees, officers, directors, contractors, business associates, volunteers, health care students, interns, residents, fellows, and affiliates.
Your Health Information Rights
You have the following rights with respect to PHI about you:
Obtain a paper or electronic copy of the Notice upon request. You may request a copy of the Notice at any time. Even if you have agreed to receive the Notice electronically, you are still entitled to a paper copy. You may obtain a paper copy at the Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) clinic location or by calling Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) at 470-645-1477.
Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use or disclosure of PHI about you for treatment, payment, health care operations, communication with individuals involved in your care or by our Business Associates by submitting a written request for the restriction. We are not required to agree to those restrictions. You have the right to restrict certain disclosures of PHI to a health plan where you pay out of pocket in full for the health service. You may submit your request in person at the Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) clinic or by mail to the attention of our business correspondence address: Balanced Body and Mind OT, LLC, 1101 Juniper St NE, Unit 709, Atlanta GA 30309.
Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you contained in a designated record set for as long as we maintain the PHI. You also have the right to an electronic copy of that information. The designated record set usually will include treatment, and/or billing records. To inspect or copy the designated record set or to receive an electronic copy of PHI about you, you must send a written request. You may submit your request in person at the Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) clinic or by mail to our business correspondence address at 1101 Juniper St NE, Unit 709, Atlanta, GA 30309. We may charge you a fee for the costs of copying, mailing and supplies that are necessary to fulfill your request. We may deny your request in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed.
Request an amendment of PHI. If you believe that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to the attention of our business correspondence address at 1101 Juniper St NE, Unit 709, Atlanta GA 30309. You must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision and we may give a rebuttal to your statement.
Receive an accounting of disclosures of PHI. You have the right to receive an accounting of the disclosures we have made of PHI about you after May 1, 2023 for most purposes other than treatment, payment, or health care operations. The accounting will exclude certain disclosures, such as disclosures made directly to you, disclosures you authorize, disclosures to friends or family members involved in your care, and disclosures for notification purposes. The right to receive an accounting is subject to certain other exceptions, restrictions, and limitations. To request an accounting, you must submit a request in writing to the attention of our business correspondence address. Your request must specify the time period and must be limited to a period within six years of the date of the request. The first accounting you request within a 12-month period will be provided free of charge, but you may be charged for the cost of providing any additional accountings in the same 12-month period. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.
Request communications of PHI by alternative means or at alternative locations. For instance, you may request that we contact you about medical matters only in writing or at a different residence or post office box. To request confidential communication of PHI about you by an alternative means or at an alternative location, you must submit a request in writing. You may submit your request in person at the Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) clinic or by mail to the attention of our business correspondence address at 1101 Juniper St NE, Unit 709, Atlanta, GA 30309. Your request must state how or where you would like to be contacted. We will accommodate all reasonable requests.
Receive Notification of a Breach. You will receive notification of a breach of any unsecured PHI that compromises the privacy or security of your PHI.
Examples of How We May Use and Disclose PHI
The following are descriptions and examples of ways we use and disclose PHI:
1. Treatment – We will use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes disclosure to your physician or other health care providers who become involved in your care.
2. Within our office for administrative activities, quality assessment, oversight and peer review.
3. With billing personnel and as necessary to obtain payment for your health care services.
4. With your insurance company or other payers as required for payment.
5. With the referring agency and case manager, if applicable.
6. With any provider, school, or agency with your written request.
You may request written or verbal information sharing in writing. Your request should include a specified period of time for information sharing.
We will use and disclose PHI for treatment. Examples: Information obtained by Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) health care providers or other personnel will be used to provide health care related services to you. We will document in your record information related to the health care services provided to you. Our health care providers, other personnel and/or business associates may collect information about you in order to provide these services and monitor your progress within the program. We may also share this information with your physician and/or other health care providers as needed to coordinate your care.
We will use and disclose PHI for payment. Example: We will contact your third-party payer to determine whether it will pay for your services, prescription, and/or supplies, as applicable, and the amount of your copayment. We will bill you or a third-party payer for the cost of services and/or supplies provided to you. The information on or accompanying the bill may include information that identifies you, as well as services and supplies received.
We will use and disclose PHI for health care operations. Examples: Balanced Body and Mind OT may use information in your health record to monitor the performance of the health care providers providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service we provide. Also, in the rare event our clinic is sold by Balanced Body and Mind OT, we may transfer patient records to the purchaser.
We are likely to use or disclose PHI for the following purposes:
Health-related communications: Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) provides a special customer care service to its customers. Under this program, we may contact you, consistent with applicable law, to provide appointment reminders, information about treatment alternatives (including the availability of clinical trials), or other health-related benefits and services that may be of interest to you. If you do not wish to participate in this special care service, you may notify us of this fact at any time in writing, by telephone or in person.
Parental Access: We may disclose PHI to parents, guardians, and persons acting in similar legal status. In addition, since services may be provided in your home or other natural environments, those present during the session, including friends, family, or day care providers may hear health information regarding your child. Please notify your therapist if you do not want your child’s protected health information to be discussed.
Communication with individuals involved in your care or payment for your care: Health professionals may, consistent with applicable law, disclose to a family member, other relative, close personal friend or any person you identify, PHI relevant to that person’s involvement in your care or payment related to your care if your therapist, in his or her professional judgment, determines that it is in your best interests.
Business associates: There are some services provided by us through contracts with business associates. Examples include the electronic transmission of health care claims to insurers and benefit managers, creation of paper billings for services that cannot be electronically transmitted, and payment reconciliation services. We may also contract with business associates to provide data aggregation services relating to our health care operations. When these services are contracted for, we may disclose PHI about you to our business associate so that they can perform the job we have asked them to do or to bill you or your third-party payor for services rendered. To protect PHI about you, we require our business associates to appropriately safeguard the PHI.
Public health: As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Health oversight activities: We may disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities include audits, investigations, and inspections, as necessary for our licensure and for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Worker’s compensation: We may disclose PHI about you as authorized by and as necessary to comply with laws relating to worker’s compensation or similar programs established by law.
Law enforcement: We may disclose PHI about you for law enforcement purposes to a law enforcement official as required by law, court order, warrant, or administrative request.
Judicial and administrative proceedings: If you are involved in a lawsuit or dispute, we may disclose PHI about you in response to a court or administrative order.
As required by law: We must disclose PHI about you when required to do so by law.
We will notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.
We are permitted to use or disclose PHI about you for the following purposes:
Research: We may disclose PHI about you to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your information.
Coroners, medical examiners, and funeral directors: We may release PHI about you to a coroner or medical examiner. This disclosure may be necessary, for example, to identify a deceased person, determine the cause of death or other duties as authorized by law. We may also disclose PHI to funeral directors, consistent with applicable law, to carry out their duties.
Organ or tissue procurement organizations: Consistent with applicable law, we may disclose PHI about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Correctional institution: If you are or become an inmate of a correctional institution, we may disclose PHI to the institution or its agents when necessary for your health or the health and safety of others.
To avert a serious threat to health or safety: We may use and disclose PHI about you when we believe in good faith that disclosure is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person and the disclosure is to a person reasonably able to prevent the threat. We may disclose your PHI for a medical emergency when we are unable to obtain your consent or authorization due to your condition or the nature of the medical emergency.
Military and veterans: If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate military authority.
National security and intelligence activities: We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective services for the President and others: We may disclose PHI about you to authorized federal official so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
We will never share your PHI unless you give us prior written permission in the following situations:
Use of disclosure for marketing purposes
Disclosure which may be considered a sale of your information
Federal Privacy Laws
This notice of Privacy Practices is provided to you as a requirement of Health Insurance Portability and Accountability Act (HIPAA). There are several other privacy laws that also apply including the Freedom of Information Act and the Privacy Act. These laws have been taken into consideration in developing policies and this notice of how we will use and disclose your PHI.
For More Information or to Report a Problem
If you have questions or would like additional information about Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) privacy practices, you may call Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) at 470-645-1477, or write to the attention of Balanced Body and Mind OT, LLC (“Balanced Body and Mind OT”) business correspondence address: 1101 Juniper St NE, Unit 709, Atlanta, GA 30309 Attn: HIPAA Privacy. If you believe your privacy rights have been violated, you can file a complaint with the United States Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Ave SW, Washington, D.C. 20201, or by calling 1-877-696-6775 . There will be no retaliation for filing a complaint.
This notice is effective in its entirety as of May 5, 2023.