Notice of Privacy Practices
The Vitality Center
Use and Disclosure of Health Information
The Vitality Center, Ltd. may use your health information, that is, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provision of the Health Insurance Portability and Accountability Act of 1996 (“HIPAA“), for purposes of making or obtaining payment for your care and conducting health care operations. The Vitality Center has established a policy to guard against unnecessary disclosure of your health information.
Generally, we may not use or disclose your Health Information without your permission. Further, once your permission has been obtained, we must use or disclose
your health information in accordance with specific terms of that permission.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
To Make or Obtain Payment. The Vitality Center may use or disclose your health information to make payment to or collect payment from third parties, such as
other health plans or providers, for the care you receive. For example, The Vitality Center may provide information regarding your coverage or health care
treatment to other health plans to coordinate payment of benefits.
To Conduct Health Care Operations. The Vitality Center may use or disclose health information for its own operations to facilitate the administration of The Vitality Center and as necessary to provide coverage and services to all of The Vitality Center’s participants.
Health care operations includes such activities as:
a) Quality assessment and improvement activities.
b) Activities designed to improve health or reduce health care costs.
c) Clinical guideline and protocol development, case management and care coordination.
d) Contacting health care providers and participants with information about treatment alternatives and other related functions.
e) Health care professional competence or qualifications review and performance evaluation.
f) Accreditation, certification, licensing or credentialing activities. g) Underwriting, premium rating or related functions to create, renew or replace health insurance or health benefits.
h) Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.
i) Business planning and development including cost management and planning related analyses and formulary development.
j) Business management and general administrative activities of The Vitality Center, including customer service and resolution of internal grievances. For example, The Vitality Center may use your health information to conduct case management, quality improvement and utilization review, and provider credentialing activities or to engage in customer service and grievance resolution activities.
For Treatment Alternatives. The Vitality Center may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
For Distribution of Health-Related Benefits and Services. The Vitality Center may use or disclose your health information to provide to you information on healthrelated benefits and services that may be of interest to you.
To Individuals Involved in Your Care or Payment for Your Care. The Vitality Center may release medical information about you to a friend or family member who is involved in your medical care. The Vitality Center may also give information to someone who helps pay for your care. In addition, The Vitality Center may disclose 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.
For Appointment Reminders. The Vitality Center may use your health information to contact you as a reminder that you have an appointment for treatment or medical care at this office.
When Legally Required. The Vitality Center will disclose your health information when it is required to do so by any federal, state or local law.
To Conduct Health Oversight Activities. The Vitality Center may disclose your health information to a health oversight agency for authorized activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. The Vitality Center, however, may not disclose your health information if you are the subject of an investigation and the investigation does not arise out of or is not directly related to your receipt of health care or public benefits.
In Connection With Judicial and Administrative Proceedings. As permitted or required by state law, The Vitality Center may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when The Vitality Center makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information.
For Law Enforcement Purposes. As permitted or required by state law, The Vitality Center may disclose your health information to a law enforcement official for certain law enforcement purposes, including, but not limited to, if The Vitality Center has a suspicion that your death was the result of criminal conduct or in an emergency to report a crime.
In the Event of a Serious Threat to Health or Safety. The Vitality Center may, consistent with applicable law and ethical standards of conduct, disclose your health information if The Vitality Center, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Specified Government Functions. In certain circumstances, federal regulations require The Vitality Center to use or disclose your health information to facilitate specified government functions related to the military and veterans, national security and intelligence activities, protective services for the president and others,2 and correctional institutions and inmates.
For Workers’ Compensation. The Vitality Center may release your health information to the extent necessary to comply with laws related to workers’ compensation or similar programs.
Authorization to Use or Disclose Health Information. Other than as stated above, The Vitality Center will not disclose your health information other than with your written authorization. If you authorize The Vitality Center to use or disclose your health information, you may revoke that authorization in writing at any time.
Your Rights With Respect to Your Health Information.
YOU HAVE THE FOLLOWING RIGHTS REGARDING YOUR HEALTH INFORMATION THAT THE VITALITY CENTER MAINTAINS:
Right to Request Restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on The Vitality Center’s disclosure of your health information to someone involved in the payment of your care. However, The Vitality Center is not required to agree to your request. If you wish to make a request for restrictions, please make your request in writing to The Vitality Center owner, Amber L. Hollis (see contact info below).
Right to Receive Confidential Communications. You have the right to request that The Vitality Center communicate with you in a certain way if you feel the disclosure of your health information could endanger you. For example, you may ask that The Vitality Center only communicate with you at a certain telephone number or by email. If you wish to receive confidential communications, please make your request in writing to The Vitality Center owner. The Vitality Center will attempt to honor your reasonable requests for confidential communications.
Right to Inspect and Copy Your Health Information. You have the right to inspect and copy your health information. A request to inspect and copy records containing your health information must be made in writing to The Vitality Center owner. If you request a copy of your health information, The Vitality Center may charge a reasonable fee for copying, assembling costs and postage, if applicable, associated with your request.
Right to Amend Your Health Information. If you believe that your health information records are inaccurate or incomplete, you may request that The Vitality Center amend the records. That request may be made as long as the information is maintained by The Vitality Center. A request for an amendment of records must be made in writing to The Vitality Center owner. The Vitality Center may deny the request if it does not include a reason to support the amendment. The request also may be denied if your health information records were not created by The Vitality Center, if the health information you are requesting to amend is not part of The Vitality Center’s records, if the health information you wish to amend falls within an exception to the health information you are permitted to
inspect and copy, or if The Vitality Center determines the records containing your health information are accurate and complete.
Right to an Accounting. You have the right to request a list of certain disclosures of your health information that The Vitality Center is required to keep a record of under the Privacy Rule, such as disclosures for public purposes authorized by law or disclosures that are not in accordance with the Plan’s privacy policies and applicable law. The request must be made in writing to The Vitality Center owner. The request should specify the time period for which you are requesting the information. Accounting requests may not be made for periods of time going back more than six (6) years. The Vitality Center will provide the first accounting you request during any 12 month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee. The fee is set as base fee of $30.00 for the first 10 (ten) pages, $1.00 for pages 11-60, $.50 for pages 61-400. The base fee must be paid at the time of the request and the balance due at the time of pick up or receipt.
Right to a Paper Copy of this Notice. You have a right to request and receive a paper copy of this Notice at any time, even if you have received this Notice previously or agreed to receive the Notice electronically. To obtain a paper copy, please contact the clinic.
Revisions to This Notice. We reserve the right to revise or amend This Notice at any time. Any revised Notice will be effective for medical information we already have about you, as well as any information we receive in the future. We will post a copy of any revised Notice in the clinic. In addition, each time you visit the clinic we will make a copy of the current Notice that is in effect, available to you.
Duties of The Vitality Center. The Vitality Center is required by law to maintain the privacy of your health information as set forth in this Notice and to provide to you this Notice of its duties and privacy practices. The Vitality Center is required to abide by the terms of this Notice, which may be amended from time to time. The Vitality Center reserves the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains. If Health Plan changes its policies and procedures, The Vitality Center will revise the Notice and will provide a copy of the revised Notice to you within 60 days of the change.
Complaints. You have the right to express complaints to The Vitality Center and to the Secretary of the Department of Health and Human Services if you believe that your privacy rights have been violated. Any complaints to The Vitality Center should be made in writing to The Vitality Center’s owner. The Vitality Center encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
Contact Person / Owner
Dr. Amber L. Hollis
The Vitality Center, Ltd.