This Notice of Privacy Practices (the “Notice”) describes how Tava Health, Inc. (“Tava Health,” “Tava,” “we,” or “us”) may use and disclose your or your child’s protected health information to carry out treatment, payment, or business operations and for other purposes that are permitted or required by law.
This Notice also describes your rights to access and control your Protected Health Information. “Protected Health Information” or “PHI” is information about you or your child that may be used to identify you or your child and that that was created, used, or disclosed in the course of providing a health care service. For the purposes of this document, references to “your Protected Health Information” or “your PHI” includes PHI about you or your child as it may be applicable.
When it comes to your Protected Health Information, you have certain rights. This section of the Notice explains your rights and some of our responsibilities to help you. To exercise any of these rights, please contact our Privacy Office using the contact information provided at the end of this Notice.
Get an electronic or paper copy of your medical record
You can ask to see or get an electronic or paper copy of your or your child’s medical record and other PHI we have about you. Ask us how to do this.We will provide a copy or a summary of your PHI. We may charge you a reasonable, cost-based fee to fulfill your request.
Ask us to correct your medical record
You can ask us to correct health information about you or your child that you think is incorrect or incomplete. Ask us how to do this.We may deny your request, but will provide you with a written explanation for doing so.
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 accommodate all reasonable requests.
Ask us to limit what we use or share
You can ask us not to use or share certain PHI for treatment, payment, or our operations. We are not required to agree to your request, and we may deny the request if it would affect your or you child’s 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 agree to this request unless a law requires us to share that information.
Get an accounting of disclosures
You can ask for a list (i.e., an “accounting”) of the instances when we have shared your PHI, for six years prior to the date you ask, who we shared it with, and why we shared it.As part of this accounting, 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 will provide one accounting per year at no charge to you, but we will charge you a reasonable, cost-based fee if you request another accounting within 12 months of any such request you make.
Get a copy of this Notice of Privacy Practices
You may ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. If so requested, we will provide you with a paper copy promptly.
Choose someone to act for you
If you have given someone medical power of attorney, that person can exercise your rights and make choices about your PHI. Once you have notified us that you have given someone medical power of attorney, 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 may file a complaint if you feel we have violated your or your child’s rights by contacting the Privacy Office using the contact information provided below.You also have the right to file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights (“OCR”) by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting the OCR website located at www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you or your child for filing a complaint.
For certain types of PHI, you can tell us your choices about what we share. If you have a clear preference for how we share the information in the situations described below, please tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and the choice to tell us to:
Share information with family, close friends, or others involved in your or your child’s careShare information in a disaster relief situationInclude information in a hospital directory
We may share your Protected Health Information in the event such disclosure is deemed necessary to lessen a serious and imminent threat to health or safety.
In the following cases, we never share your or your child’s information unless you give us written permission to do so:
- Marketing purposes
- Sale of your information
- Sharing of psychotherapy notes, unless otherwise required by state law
OUR USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:
Your PHI may be used and disclosed by our service providers, our staff, and others outside of our office who are involved in your or child’s treatment for the purpose of providing the health care services, supporting our business operations, obtaining payment for your or your child’s care, and any other use authorized or required by law. We never market or sell PHI.
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your or your child’s treatment and any related services. This includes the coordination or management of your or your child’s health care with a third party. For example, your PHI may be provided to any other health care provider with whom you or child have an existing treatment relationship to ensure the necessary information is accessible to diagnose or treat you or your child.
Payment: Your PHI may be used to bill or obtain payment for your health care services. For example, we may use your PHI in connection with processing payments for services provided to you.
Health Care Operations: We may use or disclose, as needed, your PHI in order to support the business activities of this office. These activities include, but are not limited to, improving quality of care, providing information about treatment alternatives or other health-related benefits and services, developing or maintaining and supporting computer systems, legal services, and conducting audits and compliance programs, including fraud, waste, and abuse investigations.
Other Uses and Disclosures that Do Not Require Your Authorization: We may use or disclose your PHI in certain situations without your authorization. These situations include the following uses and disclosures: as required by law; for public health purposes; for health care oversight purposes; for abuse or neglect reporting; pursuant to Food and Drug Administration requirements; in connection with legal proceedings; for law enforcement purposes; to coroners, funeral directors and organ donation agencies; for certain research purposes; for certain criminal activities; for certain military activity and national security purposes; for workers’ compensation reporting; relating to certain inmate reporting; and other required uses and disclosures.
We are required by law to maintain the privacy and security of your PHI. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your PHI or other private information (e.g., biometric information, security questions and answers). Notification will be made to you no later than sixty (60) days from the breach discovery and will include a brief description of how the breach occurred, the protected health information involved, and contact information for you to ask questions.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.
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 or your child. The new Notice will be available upon request, in our office, and on our web site.
When communicating with us regarding this Notice, our privacy practices, or your privacy rights, please contact our Privacy Office using the following contact information:
Tava Health, Inc. firstname.lastname@example.org