HIPAA Notice
Effective Date: March 1, 2023
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact Jason Levee or email
Jason@wholefamilyhealth.co.
1. OUR PLEDGE REGARDING PROTECTED HEALTH INFORMATION
We at Whole Family Health understand that protected health information about you and your
health is personal. We are committed to protecting the health information about you. This Notice
applies to all records of your care generated by Whole Family Health whether made by our
personnel or your personal doctor.
This Notice will tell you about the ways in which we may use or disclose protected health
information about you. We also describe your rights and certain obligations we have regarding
the use and disclosure of protected health information. Federal law requires us to:
• Make sure that protected health information that identifies you is kept private;
• Notify you about how we protect protected health information about you;
• Explain how, when, and why we use and disclose protected health information; and
• Follow the terms of the Notice that is currently in effect.
We are required to follow the procedures in this Notice. We reserve the right to change the terms
of this Notice and to make new Notice provisions effective for all protected health information
that we maintain by:
• Making copies of the revised Notice available upon request; and
• Posting the revised Notice on our Website.
2. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION
ABOUT YOU
The following categories describe different ways that we may use and disclose protected health
information without your written authorization:
For Treatment
We may use protected health information about you to provide you with, coordinate, or
manage your medical treatment or services. We may disclose protected health
information about you to doctors, nurses, technicians, medical students, or other Whole
Family Health personnel, including persons outside of our office who are involved in
your medical care. Whole Family Health may also share protected health information
about you in order to coordinate your care for such reasons as prescriptions or lab work.
We may use and disclose protected health information to contact you as a reminder that
you have an appointment with Whole Family Health. We may use and disclose protected
health information to tell you about or recommend possible treatment options, treatment
alternatives, or health-related benefits or services that may be of interest to you.
For Payment for Services
We may use and disclose protected health information about you so that the treatment and
services you receive at Whole Family Health may be billed to and payment may be
collected from you, an insurance company, or a third-party. For example, we may need to
give your health plan information about nutrition services you received at Whole Family
Health so your health plan will pay us or reimburse you for the service. We may also tell
your health plan about the nutrition services you are going to receive to obtain prior
approval or to determine whether your plan will cover the treatment.
For Health Care Operations
We may use and disclose protected health information about you for Whole Family
Health healthcare operations, such as our quality assessment and improvement activities,
case management, coordination of care, business planning, customer service, and other
activities. These uses and disclosures are necessary to run the facility, reduce health care
costs, and make sure that all of our clients receive quality care.
For example, we may use protected health information to review our treatment and
services or to evaluate the performance of the dietitian who is providing your services.
We may also combine protected health information about many Whole Family Health
clients to decide what additional services we should offer, what services are not needed,
and whether certain treatments are effective.
Subject to applicable state law, the law allows or requires us to use or disclose your
health information without your authorization in some limited situations for purposes
beyond treatment, payment, and operations.
As Required by Law
We will disclose protected 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 protected health information when necessary to prevent a
serious threat to your health and safety or the health and safety of the public or another
person.
We may also disclose protected health information about you to a government authority if
we reasonably believe that you are a victim of abuse, neglect, or domestic violence. We
will only disclose this type of information to the extent required by law, and we will only
disclose it if (a) you agree to the disclosure, or (b) the disclosure is allowed by law and
we believe it is necessary to prevent or lessen a serious and imminent threat to you or
another person.
Judicial and Administrative Proceedings
We may disclose your protected health information in response to a court or
administrative order. We may also disclose your protected health information in response
to a subpoena, discovery request, or other lawful processes by someone else involved in
the dispute, but only if efforts have been made, either by us or the requesting party, to tell
you about the request or to obtain an order protecting the information requested.
Business Associates
We may disclose information to business associates who perform services on our behalf
(such as billing companies). However, we require that these associates appropriately
safeguard your information. Our business associates are obligated to protect the privacy
of your information and are not allowed to use or disclose any information other than as
specified in our contract.
Public Health
As required by law, we may disclose your protected health information to public health or
legal authorities charged with preventing or controlling disease, injury, or disability.
Health Oversight Activities
We may disclose protected health information to a health oversight agency for activities
authorized by law. These activities include audits, investigations, and inspections, as
necessary for licensure and for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
Law Enforcement
We may release protected health information as required by law, or in response to an
order or warrant of a court, a subpoena, or an administrative request. We may also
disclose protected health information in response to a request related to the identification
or location of an individual, a victim of crime, a decedent, or a crime on the premises.
Special Government Functions
If you are a member of the armed forces, we may release protected health information
about you if it relates to military and veterans’ activities. We may also release your
protected health information for national security and intelligence purposes, protective
services for the President, and medical suitability or determinations made by the
Department of State.
Coroners, Medical Examiners, and Funeral Directors
We may release protected health information to a coroner or medical examiner. This
release may be necessary, for example, to identify a deceased person or determine the
cause of death. We may also disclose protected health information to funeral directors,
consistent with applicable laws, to enable them to carry out their duties.
Worker’s Compensation
We may disclose protected health information as necessary to comply with laws relating
to worker’s compensation or other similar programs established by law.
Food and Drug Administration (FDA)
We may disclose to the FDA, or persons under the jurisdiction of the FDA, protected
health information relative to adverse events with respect to drugs, foods, supplements,
products, and product defects, or post-marketing surveillance information to enable
product recalls, repairs, or replacement.
3. YOU CAN OBJECT TO CERTAIN USES AND DISCLOSURES
Unless you object, or request that only a limited amount or type of information be shared, we
may use or disclose protected health information about you in the following circumstances:
• We may share with a family member, relative, friend or other person identified by you
protected health information that is directly relevant to that person’s involvement in your
care or payment for your care. We may also share information to notify these individuals
of your location, general condition, or death.
• We may share protected health information with a public or private agency (such as the
American Red Cross) for disaster relief purposes. Even if you object, we may still share
this information, if necessary, under emergency circumstances.
If you would like to object to the use and disclosure of protected health information in these
circumstances, please call or write to the contact person listed on this Notice.
4. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT
YOU
You have the following rights regarding protected health information that we maintain about
you:
Right to Inspect and Copy
You have the right to inspect and copy protected health information that may be used to
make decisions about your care or payment for your care. If we maintain your protected
health information electronically, you can request that we provide access in an electronic
form and format that is readily producible, or in a form and format agreed to by us.
To inspect and copy protected health information that may be used to make decisions
about you, you must submit your request in writing to Whole Family Health at
Jason@wholefamilyhealth.co. If you request a copy of the information, we may charge a
fee for the costs of copying, mailing, or supplies associated with your request. We may
not charge you a fee if you need the information for a claim for benefits under the Social
Security Act or any other state or federal needs-based benefit program. We will respond
to your request no later than 30 days after we receive it. There are certain situations in
which we are not required to comply with your request. In these circumstances, we will
respond to you in writing, stating why we will not grant your request and describe any
rights you may have to request a review of our denial.
Right to Amend
If you feel that the protected health information we have about you is incorrect or
incomplete, you may ask us to amend or supplement the information.
To request an amendment, your request must be made in writing and submitted to Whole
Family Health at Jason@wholefamilyhealth.co. In addition, you must provide a reason
that supports your request. We will act on your request for an amendment no later than 60
days after we receive it.
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 these circumstances, we will provide a written denial
stating why we will not grant your 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 protected health information kept by Whole Family Health;
• Is not part of the information that you would be permitted to inspect and copy; or
• We believe 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 the
disclosures we made of protected health information about you.
To request this list of disclosures, you must submit your request in writing to Whole
Family Health at Jason@wholefamilyhealthco. You may ask for disclosures made within
the six years before your request. The first list you request within a 12-month period will
be free. For additional lists in that 12-month period, we may charge you for the costs of
providing the list. We are required to provide a list of all disclosures except the following:
• Disclosures made for your treatment;
• Those used for billing and collection of payment for your treatment;
• Those related to health care operations;
• Those made to you or requested by you, or those that you authorized;
• Those that occurred as a byproduct of permitted use and disclosures;
• Those used for national security or intelligence purposes, or provided to
correctional institutions or law enforcement regarding inmates;
• Those that were a part of a limited data set of information that does not contain
information identifying you.
Right to Request Restrictions
You have the right to request a restriction or limitation on the protected health
information we use or disclose about you for treatment, payment, or health care
operations, or to persons involved in your care.
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, the
disclosure is to the Secretary of the Department of Health and Human Services, or the
disclosure is required by law.
To request restrictions, you must make your request in writing to Whole Family Health at
Jason@wholefamilyhealth.co.
Right to Request Confidential Communications
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 ask that we only contact you at
work or by mail.
To request confidential communications, you must make your request in writing to Whole
Family Health at Jason@wholefamilyhealth.co. 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 at any time. To receive a paper copy,
contact Whole Family Health at Jason@wholefamilyhealth.co.
Right to Receive Notice of Breach
You have a right to be notified upon a breach of any of your unsecured protected health
information.
Rights for Out-of-Pocket Payments
If you paid out of pocket in full for a specific item or service, you have a right to ask that
your protected health information with respect to that item or service not be disclosed to a
health plan for purposes of payment or health care operations. We are required to agree to
your request unless the disclosure is otherwise required by law.
5. TYPES OF USES AND DISCLOSURES REQUIRING AUTHORIZATION
Most uses and disclosures of psychotherapy notes require us to obtain authorization from you. In
addition, in most instances, we cannot use or disclose your protected health information for
marketing purposes or sell your protected health information without your written authorization.
Finally, any other use or disclosure not described in this Notice will be made only with your
authorization. Any time you provide us with a written authorization, you may revoke it any time
in writing, to the extent that we have not already taken action in reliance on your previous
authorization.
6. OTHER USES AND DISCLOSURES
We will obtain your written authorization before using or disclosing your protected health
information for purposes other than those described in this Notice (or as otherwise permitted or
required by law). You may revoke this authorization in writing at any time. Upon receipt of the
written revocation, we will stop using or disclosing your information, except to the extent that
we have already taken action in reliance on the authorization.
7. YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES
If you believe your privacy rights have been violated, you may file a complaint with Whole
Family Health at Jason@wholefamilyhealth.co or file a written complaint with the Secretary of
the Department of Health and Human Services. A complaint to the Secretary should be filed
within 180 days of the occurrence or action that is the subject of the complaint.
If you file a complaint, we will not take any action against you or change our treatment of you in
any way.
8. CHANGES TO THIS NOTICE
We reserve the right to change this Notice and make the new Notice apply to health information
we already have, as well as any information we receive in the future. We will post a copy of our
current Notice on our website. The notice will have the effective date clearly marked at the top of
the page.
