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
Your Rights
You have the right to:
- Get a copy of your paper or electronic medical record
- Correct your paper or electronic medical record
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we’ve shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
- Tell family and friends about your condition
- Provide disaster relief
- Market our services and sell your information
Our Uses and Disclosures
We may use and share your information as we:
- Treat you
- Run our organization
- Bill for your services
- Help with public health and safety issues
- Do research
- Comply with the law
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
Your Rights — In Detail
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
- We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
- You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
- We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home, office, or cell phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say “no” if it could affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share it.
Get a list of those with whom we’ve shared information
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures. We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
- If someone has authority to act as your personal representative (for example, a medical power of attorney or legal guardian), that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/hipaa/filing-a-complaint/index.html.
- We will not retaliate against you for filing a complaint.
Your Choices — In Detail
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care or payment for your care
- Share information in a disaster relief situation
If you are not able to tell us your preference, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
Our Uses and Disclosures — In Detail
How do we typically use or share your health information?
Treat you. We can use your health information and share it with other professionals who are treating you. Example: We may share information with another provider involved in your care.
Run our organization. We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Bill for your services. We can use and share your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.
How else can we use or share your health information?
We are allowed or required to share your information in other ways — usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.
- Help with public health and safety issues (such as preventing disease, reporting suspected abuse, neglect, or domestic violence, or reducing a serious threat to health or safety)
- Do research
- Comply with the law, including with the Department of Health and Human Services to confirm we are complying with federal privacy law
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions, including in response to a court or administrative order or a subpoena
Additional Protections Under California Law
California’s Confidentiality of Medical Information Act (CMIA) and related laws provide privacy protections that are in some cases stronger than federal HIPAA requirements. Where they apply, we follow the stricter standard:
- We will not share your medical information except as permitted by both HIPAA and the California Confidentiality of Medical Information Act (CMIA).
- We will not disclose information about certain sensitive services (for example, mental health, reproductive or sexual health, or substance use treatment) without your written authorization, except where treatment requires it or another law requires us to share it.
- Where California law requires your specific written authorization for a disclosure that HIPAA would otherwise permit, we will obtain that authorization first.
Telehealth Services
We offer some services by telehealth (live video or other electronic means). When we provide care this way, the same privacy protections in this notice apply to your information. Before your first telehealth visit, we will obtain your consent to use telehealth and explain how it differs from an in-person visit, including potential risks to the privacy and security of information transmitted electronically and the possibility of technical interruptions.
- We use telehealth and recordkeeping technology that is designed to protect your information, including encryption and access controls, and we maintain written agreements (Business Associate Agreements) with the vendors that handle your information on our behalf.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
Electronic Records and Patient Portal
We maintain your records electronically and offer a secure patient portal you can use to communicate with us, complete intake forms, view information, and make payments. We use third-party service providers (business associates) — such as our electronic health record, scheduling, and payment-processing vendors — to help us operate, and we require them by written agreement to safeguard your information.
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We will not use or share your information other than as described in this notice unless you tell us we can in writing. If you tell us we can, you may change your mind at any time — let us know in writing.
Changes to the Terms of This Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site at www.withtheseasonswellness.com.
Contact Us / Privacy Official
If you have questions about this notice or wish to exercise any of your rights, contact our Privacy Official:
Sarah Siegel, Owner
With The Seasons LLC
1019 Solano Avenue, Unit B, Albany, CA 94706
Phone: (510) 224-3698 | Email: hello@withtheseasonswellness.com
Website: www.withtheseasonswellness.com
We never sell your personal information.
