HIPAA Notice of Privacy Practices

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.

Align Integrative Wellness, LLC (“Align”) is required by law to maintain the privacy of your protected health information (“PHI”), provide you with this Notice of our legal duties and privacy practices regarding PHI, notify you following a breach of unsecured PHI, and abide by the terms of this Notice.

How we may use and disclose your PHI

For treatment

We use and disclose PHI to provide, coordinate, and manage your healthcare, including consultations, prescriptions, lab orders, referrals, and follow-up care. We may share PHI with other healthcare providers involved in your treatment, including labs (e.g., LabCorp, Quest, specialty labs) and compounding pharmacies that fulfill your prescriptions.

For payment

We use and disclose PHI to obtain payment for our services, including processing payments through our payment processor. If we bill insurance on your behalf (when credentialed and applicable), we may disclose PHI to your insurer for claims processing.

For healthcare operations

We use and disclose PHI for activities necessary to operate our practice, including quality assessment, credentialing, internal audits, training, and administrative functions.

Other permitted or required uses and disclosures

We may use or disclose PHI without your authorization in these circumstances:

• When required by law (e.g., reporting communicable diseases, child abuse, court orders)
• For public health activities (e.g., reporting to public health authorities)
• For health oversight activities (audits, investigations, licensure)
• For judicial or administrative proceedings (in response to valid court orders or subpoenas)
• For law enforcement purposes as permitted by law
• To prevent serious harm to you or others
• For research only with proper authorization or IRB waiver (we do not currently conduct research)
• To family/friends involved in your care only with your verbal or implicit agreement

Uses and disclosures requiring your written authorization

The following uses and disclosures require your specific written authorization:

• Most uses and disclosures of psychotherapy notes (we do not maintain such notes)
• Marketing communications (other than face-to-face or limited promotional gifts)
• Sale of PHI (we do not sell PHI under any circumstances)
• Any other use or disclosure not described in this Notice

You may revoke any authorization at any time, in writing, except to the extent we have already acted on it.

Your rights regarding your PHI

Right to inspect and copy

You have the right to inspect and obtain a copy of your PHI maintained in our designated record set. We may charge a reasonable, cost-based fee for copies. Requests must be in writing.

Right to amend

You may request that we amend PHI we maintain about you. We may deny your request in certain circumstances; if denied, you have the right to submit a written statement of disagreement that becomes part of your record.

Right to an accounting of disclosures

You have the right to request an accounting of certain disclosures of your PHI we have made, other than disclosures for treatment, payment, healthcare operations, and certain other permitted disclosures.

Right to request restrictions

You have the right to request restrictions on certain uses and disclosures of your PHI. We are not required to agree to all requested restrictions, except that we must agree to restrict disclosure to a health plan if you have paid out-of-pocket in full for the service.

Right to confidential communications

You have the right to request that we communicate with you about your PHI by alternative means or at alternative locations. We will accommodate reasonable requests.

Right to a paper copy of this Notice

You have the right to a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

Right to be notified of a breach

You have the right to be notified following a breach of your unsecured PHI.

Our duties

We are required by law to maintain the privacy of your PHI, provide you with this Notice, abide by its terms, notify you following a breach of unsecured PHI, and inform you of the right to opt out of fundraising communications (we do not currently conduct fundraising).

We may change this Notice from time to time. The new Notice will apply to all PHI we maintain. The effective date at the top of this page reflects the most recent version. Updated Notices will be posted on this Site and made available in our practice.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

To file a complaint with us:

Privacy Officer
Align Integrative Wellness, LLC
Mailing address available on request
care@alignintegrative.com
(385) 316-1345

To file a complaint with HHS:

Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
Phone: 1-877-696-6775
www.hhs.gov/ocr

Contact

Privacy Officer / Designated Contact for HIPAA matters:
Align Integrative Wellness, LLC
Mailing address available on request
care@alignintegrative.com
(385) 316-1345