Health Insurance Portability and Accountability Act (HIPAA) Notice of Privacy Practices

This notice describes how medical information about you maybe used and disclosed and how you can get access to this information.  Please review this information carefully.

Note: If you have questions about this notice, please use the above information located in the header to contact Smiles Psychiatry & Wellness, LLC.

WHO WILL FOLLOW THIS NOTICE

This notice describes the privacy practices of Smiles Psychiatry & Wellness, LLC.  Our staff may have access to information in your chart for treatment, payment and health care operations, which are described below, and may use and disclose information as described in this Notice.  This notice also applies to any volunteer or trainee we allow to help you while seeking services from us.

OUR PLEDGE REGARDING THE PRIVACY OF YOUR MEDICAL INFORMATION

Your medical information includes information about your physical and mental health. We understand that information about your physical and mental health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care and services and comply with certain legal requirements. This notice applies to any and all of the records of your care in our possession.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights in certain obligations we have regarding the use and disclosure of medical information.

We reserve the right to revise or amend this notice, and the changes will apply to all information we have about you. The notice will be available upon request and on our web site.

OUR OBLIGATIONS TO YOU

We are required by law to:

a.     Make sure that medical information that identifies you is kept private except otherwise provided by state or federal law;

b.     Give you this notice of our legal duties and privacy practices with respect to medical information about you; and

c.     Follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we may use and disclose medical information for each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. This notice covers payment, treatment, and what are called health care operations, as discussed below.  It also covers other uses and disclosures for which a consent or authorization are not necessary.

For treatment

1. We may use medical information about you to provide you with medical treatment or services without consent or authorization unless otherwise required by applicable state law. We may disclose medical information about you to doctors, pharmacists, laboratories, or other healthcare providers, case managers, case coordinators or other service providers who are involved in taking care of you whether or not they are affiliated with us.  For example we may disclose medical information concerning you to the local hospital, physicians or counselors who care for you as well as any other entity that has provided or will provide care to you.

2. We will disclose any mental health information, including psychotherapy notes, AIDS or HIV-related information, drug treatment information, that we have about you only with written authorization as required by Ohio law, HIPAA and other federal regulations.

3. During the course of your treatment, we may refer you to other healthcare providers with which you may not have direct contact. These providers are called “indirect treatment providers.” “Indirect treatment providers” are required to comply with the privacy requirements of state and federal law and keep your medical information confidential. These providers will be bound by the HIPAA privacy rule.

For payment

4. We may use and disclose medical information about you without consent or authorization so that the treatment and services you receive from us may be billed to and payment may be collected from you, an insurance company or third party.  For example, we may need to give your health plan information about treatment received so your health plan will pay us or reimburse you for the treatment.  We may also tell your health plan or insurance company about a treatment you are going to receive to obtain prior approval or to determine whether it will cover the treatment.  We may also provide your information to case coordinators or case managers for payment purposes as well.

For healthcare operations

5. We may use and disclose medical information about you without consent or authorization for “health care operations.” These uses and disclosures are necessary to operate Smiles Psychiatry and Wellness, LLC and make sure that all individuals receive quality care.  For example, we may use medical information or mental health treatment information to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may also disclose your protected health information to doctors, staff or consultants for review and learning purposes. We may also use your protected health information in preparing for litigation.

Appointment reminders

6. We may use and disclose medical information to contact you by mail or phone to remind you that you have an appointment for a treatment, unless you tell us otherwise in writing.

Treatment alternatives

7. We may use and disclose information medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. However, we will not use or disclose medical information to market other products and services, either ours or those of third parties, without your authorization.

Health-related benefits and services

8. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

Individuals involved in your care of payment for your care

9.  We may release your medical information, including mental health information, prescription information, appointment information, and/or other treatment information, to an individual who is involved in your medical care as authorized by you or permitted by state and federal law.  We may also provide billing information.  In addition, we may disclose limited medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.  If Ohio law requires specific authorization for such disclosures, we will obtain an authorization from you prior to such disclosures.

As required by law

10. We will disclose medical information about you when required to do so by federal, state or local law without your consent or authorization.

To avert a serious threat to health or safe safety

11. We may disclose medical information about you were necessary to prevent a serious threat to your health and safety or health and safety of the public or another person.

To business associates

12. Smiles Psychiatry and Wellness, LLC from time to time will hire consultants called “business associates” who render services to us. We may disclose your medical information to such business associates without your consent or authorization.  Business associates are required to maintain and comply with the privacy requirements of state and federal law and keep your medical information confidential. Examples of “business associates” are accounting firms that we hired to perform audits of our billing and payment information, and computer software vendors who assist us in maintaining and processing medical information.

Worker's compensation, law enforcement, and other government requests

13. If required by law, we may share or use information about you:

a.     For workers’ compensation claims

b.     For law enforcement purposes or with a law enforcement official

c.     With health oversight agencies for activities

d.     For special government functions such as military, national security, and presidential protective services

Public health risks

14. We may disclose medical information about you for public health activities without your consent or authorization.  These activities generally include the following:

a.     To prevent or control disease, injury or disability;

b.     To report reactions to medications or problems with products;

c.     To notify people of recalls of products they may be using;

d.     To notify a person who has been exposed to a disease or may be at risk for contracting or spreading a disease or condition;

e.     To notify the appropriate government authority if we believe an individual has been the victim of abuse, neglect or domestic violence. We will we make this disclosure if you agree or when required or authorized by law.

Health oversight activities

15. We may disclose medical information to a health oversight agency, such as Department of Health and Human Services, for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with the civil rights laws.

Lawsuits and administrative proceedings

16. We may be required to disclose medical information about you in response to lawful process served by a party in a legal proceeding.

Coroners, medical examiners, and funeral directors

17. We may release medical information including mental health information to a coroner or medical examiner.  This may be necessary, for example, to identify a decreased person or determine the cause of death.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You or your personal representative have the following rights regarding medical information we maintain about you (when we say “you” this also means your personal representative, which may be your parent or legal guardian or other individual who is authorized to care for you):

Right to inspect and copy

1. You have the right to inspect and copy medical information that may be used to make decisions about your care.  If you wish to be provided a copy of your medical information that may be used to make decisions about you, you must submit your request in writing to the Privacy Officer at Smiles Psychiatry & Wellness, LLC.  If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing and/or other supplies associated with your request.

2. We may deny your request to inspect and/or copy in certain very limited circumstances.  If you are denied access to medical information, you may request that the denial be reviewed.  Another licensed health care professional chosen by us will review your request and the denial.  The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review.

Right to request an amendment

3.     If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by or for us.  To request an amendment, you request must be made in writing and submitted to the Privacy Officer at Smiles Psychiatry & Wellness, LLC.  In addition, you must provide a reason that supports your request. 

4.     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:

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

b.     Is not part of the medical information kept by us;

c.     Is not part of the information which you would be permitted to inspect and copy; or

d.     Is accurate and complete.

Right to an accounting of disclosures

5. You have the right to request an “accounting of disclosures.” This is a list of medical information disclosures made about you, including all disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make).

6. To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer at Smiles Psychiatry & Wellness, LLC.  Your request must state a time period.

Right to request restrictions

7. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations.  You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.  However, you will need to make alternative arrangements for payment if you restrict access of individuals responsible for the payment of your care.

8. 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 ensure your safety or the safety of others, or required by law.

9. To request restrictions, you must make your request in writing to the Privacy Officer at Smiles Psychiatry & Wellness, LLC.  In your request, you must tell us:

a.     What information you want to limit;

b.     Whether you want to limit our use, disclosure, or both; and

c.     To whom you want the limits to apply, for example, disclosure to your spouse.

Right to request confidential communications

10. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you can that we only contact you at work or by mail.

11. To request confidential communications, you must make your request in writing to the Privacy Officer at Smiles Psychiatry & Wellness, LLC.  We will not ask the reason for your request.  We will accommodate all reasonable requests.  Your request must specify how or where you wish to be contacted.

Right to a paper copy of this notice

12. You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services.  To file a complaint with us, submit your complain in writing to the Privacy Officer at Smiles Psychiatry & Wellness, LLC.  You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other use and disclosures of medical information not covered by this notice or the laws that apply to use will be made only with your written permission as set out in an authorization signed by you.  If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will not longer use or disclose medical information about you for the reasons covered by your written authorization.  You understand that we about 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 that we provided to you.

  This notice is effective as of May 5, 2024.