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.
The information on this page tells you about the HIPAA Privacy Rule, a federal law designed to help protect the privacy of that health information. This Notice of Privacy Practices describes how we may use and disclose patient information for treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Protected health information (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
Generally, when this Notice uses the words “you” or “your” it is referring to the patient who is the subject of patient information. However, when this Notice discusses rights regarding patient information, including rights to access or authorize the disclosure of patient information, “you” and “your” may refer to a minor-patient’s parent(s), legal guardian or other personal representative, or, as applicable, an adult patient’s personal representative.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you.
Example: A clinician treating you for anxiety asks your primary care doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Payment 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?
Light On Anxiety may use or disclose your protected health information in the following situations without your authorization or providing you the opportunity to agree or object. For each category of uses or disclosures, Light On Anxiety will explain what it means and present some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
As Required by Law. Light On Anxiety will disclose your protected health information to the extent that it is required by federal, state, or local law.
Public Health Activities. Light On Anxiety may disclose your protected health information for public health activities. These activities generally include the following: to prevent or control disease, injury, or disability; to report births and deaths; to report child abuse or neglect; to report adverse reactions to medications or problems with products; to enable product recalls; to enable public health investigations; to notify a person who may have been exposed to a communicable disease or may otherwise be at risk for contracting or spreading a disease or condition.
Victims of Abuse, Neglect or Domestic Violence. Light On Anxiety may disclose your protected health information if we reasonably believe that you are a victim of abuse, neglect or domestic violence to the appropriate government authority. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities. Light On Anxiety may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, licensure and disciplinary actions. These activities are necessary for the government to oversee the health care system and compliance with civil rights laws. Your written authorization may be required with respect to certain disciplinary proceedings under state law.
Judicial and Administrative Proceedings. Light On Anxiety may disclose your protected health information in the course of a judicial or administrative proceeding. We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process. In certain situations, your written authorization may be required under state law.
Law Enforcement. Light On Anxiety may disclose your protected health information if asked to do so by a law enforcement official including, but not limited to, the following: in response to a court order, court ordered warrant, or a subpoena or summons issued by a judicial officer; for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person; about a suspected victim of a crime if the individual agrees or under other certain limited circumstances; about the death of an individual if Light On Anxiety believes the death may be the result of criminal conduct; and about criminal conduct that occurred on the premises of Light On Anxiety.
Coroners, Medical Examiners, and Funeral Directors. Light On Anxiety may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent.
Research. Light On Anxiety may disclose your protected health information to researchers when an institutional review board or privacy board has approved a waiver of authorization, reviewed the research proposal, established protocols to ensure the privacy of the requested information, and approved the research.
To Avert a Serious Threat to Health or Safety. Light On Anxiety may use and disclose your protected health information when necessary to prevent or lessen a serious and imminent threat to your health or safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat.
Specialized Government Functions. If you are a member of the armed forces, Light On Anxiety may release your protected health information as required by military command authorities. We may also release protected health information about foreign military personnel to the appropriate foreign military authority. Light On Anxiety may also release your protected health information to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities authorized by law.
Workers’ Compensation. Light On Anxiety may release your protected health information for workers’ compensation or similar programs.
Business Associates. There are some services that may be provided through non-employed contractors including vendors, professionals and those who assist with treatment, payment or health care operations and are in need of access to your protected health information. To protect your health information, Light On Anxiety requires business associates to appropriately safeguard your information under the same regulatory standards with which LOA must comply.
- 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 here 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 if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
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.
- We may deny your request if we believe the disclosure will endanger your life or another person’s life, but you may have a right to have this decision reviewed.
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 or office 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 to your request, and we may say “no” if it would 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 that information.
- You can ask us not to share your health information with family members or friends by stating the specific restriction requested and to whom you want the restriction to apply.
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 (such as any you asked us to make). 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 you have given someone medical power of attorney or if someone is your 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.
- 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/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
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.
- Share information in a disaster relief situation.
- Include your information in a hospital directory.
If you are not able to tell us your preference, for example if you are unconscious, 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
Changes to the Terms of this Notice
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of this Notice at any time. A new Notice will be effective for all PHI that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. Copies of this Notice are available in our offices and on our website.
The effective date of this notice is December 2, 2021.