Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION MAY BE USED AND DISCLOSED BY Iris Wellness Group, AND HOW IT MAY BE ACCESSED BY Iris Wellness Group CLIENTS.
PLEASE REVIEW IT CAREFULLY.
I. Purpose of This Notice of Privacy Practices
This Notice describes the health information privacy practices of Iris Wellness Group, and the physicians, nurses, health coaches and other personnel who work in Iris Wellness Group or who provide Iris Wellness Group Services. It applies at all Iris Wellness Group locations.
II. Iris Wellness Group’s Privacy Obligations
Under the federal Health Insurance Portability and Accountability Act of 1996 and the implementing regulations, the Health Information Technology for Economic and Clinical Health (HITECH) chapter of the American Recovery and Reinvestment Act of 2009 (ARRA) and its implementing regulations and other applicable state and federal laws, (collectively, the “Laws”), as a provider of clinic services, Iris Wellness Group is required by law to maintain the privacy of it client’s health information (“Protected Health Information” or “PHI”) and to provide each client with this Notice of Privacy Practices regarding Protected Health Information. When Iris Wellness Group uses or discloses Protected Health Information, it is required to abide by the terms of its privacy as reflected in this Notice as it may be amended or updated from time to time.
The Laws divide uses and disclosures of PHI into those which can be done without client authorization and those which require client authorization. Section III describes uses and disclosures that can be done without client authorization. Section IV describes uses and disclosures that can be made only with written client authorization.
III. Permissible Uses and Disclosures Without a Written Authorization – Acute Care Services
A. Uses and Disclosures For Treatment, Payment and Health Care Operations. Iris Wellness Group may use and disclose acute care PHI under federal law in order to provide treatment, receive payment or engage in healthcare operations as described below:
Treatment. Iris Wellness Group may use and disclose PHI to provide diagnosis and treatment to a client. Consistent with that use and disclosure, Iris Wellness Group may contact or provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest and to disclose PHI to other providers involved in a client’s treatment.
Payment. Iris Wellness Group may use and disclose PHI to obtain payment for acute care services that Iris Wellness Group provides, for example to your health plan. The ARRA provides, however, that you may pay for the services and request that your PHI not be disclosed to the health plan for that service.
Health Care Operations. Iris Wellness Group may use and disclose your PHI for health care operations, which include administration, management and activities that improve the quality and cost effectiveness of care.
B. Disclosure to Relatives, Close Friends and Other Caregivers. Iris Wellness Group may use or disclose PHI to a client’s family member, other relative, a close personal friend or any other person identified by a client without a written authorization only when such client is present for, or otherwise available prior to, the disclosure, if Iris Wellness Group obtains and documents the client’s assent.
If a client is not present, or the opportunity to agree or object to a use or disclosure cannot practicably be provided because of incapacity or an emergency circumstance, Iris Wellness Group personnel may exercise professional judgment to determine whether a disclosure is in the best interest of the client. If Iris Wellness Group discloses information to a family member, other relative or a close personal friend without an authorization, Iris Wellness Group would disclose only information that Iris Wellness Group believe is directly relevant to the person’s involvement with the health care or payment related to the client’s health care. Iris Wellness Group may also disclose PHI in order to notify (or assist in notifying) such persons of a client’s location, general condition or death.
C. Public Health Activities. Iris Wellness Group may disclose PHI in order to comply with public health requirements, including but not limited to: (1) to report certain diseases, conditions or other findings to public health authorities for the purpose of preventing or controlling disease, injury or disability; (2) to report child abuse and neglect to public health authorities orother government authorities authorized by law to receive such reports; (3) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; (4) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition (under specifically limited circumstances); and (5) to report suspected abuse or neglect to a governmental authority, including a social service or protective services agency, authorized by law to receive reports of such abuse or neglect.
D. Health Oversight Activities. Iris Wellness Group may disclose PHI to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid and civil rights laws.
E. Judicial and Administrative Proceedings. Iris Wellness Group may disclose PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
F. Law Enforcement Officials. Iris Wellness Group may disclose PHI to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena.
G. Uses or Disclosures Required By Law. Iris Wellness Group may use and disclose your PHI when required to do so by any other law not already referred to in the preceding categories.
IV. Uses and Disclosures Requiring Written Authorization – Drug and Alcohol Treatment
This Section IV describes the circumstances pursuant to which Iris Wellness Group must obtain an individual’s written authorization to use or disclose PHI. A consent form is attached hereto.
Iris Wellness Group only may use or disclose PHI when it receives a written authorization for such use or disclosure for any purpose other than the ones described above in Section III, and as described below.
Behavioral Health/Drug and Alcohol Treatment Information.
Iris Wellness Group will only disclose Behavioral Health/Drug and Alcohol Treatment Information pursuant to a valid written authorization.
In addition, Iris Wellness Group shall only disclose PHI related to HIV or AIDs with the express authorization of the Individual, and for those reasons listed above.
Disclosure of Client-Oriented Information – Judicial System
With the client’s consent, information may be released to those judges who have imposed sentence on a particular client, where such sentence is conditioned upon the client entering treatment. Information released shall be limited to that provided for the purpose of the release.
With the client’s consent, information may be released to those duly authorized probation and parole officers who have been assigned responsibility to clients in treatment if the client’s probation or parole is conditioned upon his being in treatment. Information released shall be limited to that for the purpose of the release.
With the client’s consent, information may be released to judges, who have assigned a client to a project for pre-sentence, conditional release program. Pre-sentence conditional release programs include pre-indictment or pre-conviction conditional release (such as ARD) probation without verdict or disposition in lieu of trial.
With client’s consent, information released to judges, probation or parole officers, insurance company, health and hospital plan, or governmental officials, is for the purpose of determining the advisability of continuing the client with the assigned project and shall be restricted to the following:
Whether the client is or is not in treatment
The nature of the project
A brief description of the client’s progress
A short statement as to whether the client has relapsed into drug or alcohol abuse and the frequency of such relapse.
Information may be released without the client’s consent in the following situations:
Court order with a subpoena
Commission of a crime on the premise or threats to commit crimes against staff or the program. The only information released will be specific to this issue.
Suspected child abuse. The only information given will be specific to the child abuse issue only.
V. Rights Regarding Your Protected Health Information
A. For Further Information; Complaints. Further information, concerns or complaints about Iris Wellness Group’s privacy practices, or about any violations of client privacy rights or disagreements with a decision that Iris Wellness Group made regarding access to PHI, should be addressed to the Iris Wellness Group, at the following address:
Iris Wellness Group
901 Mountain Creek Rd., Chattanooga, TN 37405
A client may also file written complaints with the Office of Civil Rights of the U.S. Department of Health and Human Services, at the following address:
Office for Civil Rights U.S. Department of Health and Human Services150 S. Independence Mall West, Suite 436, Philadelphia, PA 19106
Iris Wellness Group will not retaliate against any person who reports a privacy issue or files a complaint with the Director of OCR/HHS or with the Privacy Officer.
B. Right to Request Restrictions. A client may request restrictions on Iris Wellness Group’s use and disclosure of PHI (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by the client) involved with care or with payment related to care, or (3) to prevent or limit the notification of such individuals regarding a client’s location and general condition. While Iris Wellness Group will consider all requests for restrictions carefully, Iris Wellness Group is not required to agree to a requested restriction.
C. Right to Receive Confidential Communications. Under Tennessee law, a client may request, and Iris Wellness Group will accommodate, any reasonable written request to receive his or her PHI by alternative means of communication or at alternative locations. Requests should be made to the Privacy Office in writing.
D. Right to Revoke Your Authorization. A client may revoke his or her authorization, except to the extent that Iris Wellness Group have taken action in reliance upon it, by delivering a written revocation statement to the Privacy Office identified above.
E. Right to Inspect and Copy Health Information. A client may request access to electronic medical record files, including two (2) years of disclosures, and billing records maintained by Iris Wellness Group in order to inspect and request copies of the records. Under limited circumstances, Iris Wellness Group may deny access to a portion of such records. Record requests must be made in writing to the Privacy Office. Iris Wellness Group will charge $1.00 per page, for the first 100 pages, and $0.25 per page after that, up to a maximum of $200.00 per record, plus postage costs if mailing is requested.
F. Right to Amend Records. Each client has the right to request that Iris Wellness Group amend Protected Health Information maintained in Iris Wellness Group’s electronic medical record file or billing records, by making such a request in writing to the Privacy Office. Iris Wellness Group will comply with such requests unless Iris Wellness Group believes that the amendment is inaccurate or would result in an inaccurate or incomplete record.
G. Right to Receive An Accounting of Disclosures. Upon written request to the Privacy Office, Iris Wellness Group will provide a client with an accounting of certain disclosures of PHI made by Iris Wellness Group during any period of time prior to the date of said request to the Effective Date, provided such period does not exceed six years.
H. Right to Receive Paper Copy of this Notice. Upon request, Iris Wellness Group will provide a paper copy of this Notice.
VI. Effective Date and Duration of This Notice
A. Effective Date. This Notice is and shall remain effective until replaced.
B. Right to Change Terms of this Notice. Iris Wellness Group may change the terms of this Notice at any time. If Iris Wellness Group changes this Notice, Iris Wellness Group may make the new notice terms effective for all Protected Health Information that Iris Wellness Group maintain, including any information created or received prior to issuing the new notice. Copies of any amended notice will be available from the Privacy Officer.
Chattanooga, TN 37405