If you have any questions about this notice please contact our Chief Information Officer or any staff member at Wellness Grove.
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out your treatment, collect payment for your care, and manage the operations of the organization. It also describes our policies concerning the use and disclosure of this information for other purposes that are permitted or required by law. It describes your rights to access and control of your protected health information. “Protected Health Information” (PHI) is information about you, including demographic information that may identify you, that relates to your past, present, or future physical/mental health/condition and related healthcare services. We are required by federal law to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all Protected Health Information that we maintain at that time. You may obtain revisions to our Notice of Privacy Practices by accessing our website https://www.wellnessgrove.com/notice-of-privacy-practices-npp, calling the office and requesting that a revised copy be sent to you in the mail or asking for one at the time of your next appointment.
By applying to be treated by Wellness Grove, you are implying consent to the use and disclosure of your protected health information by your provider, Wellness Grove staff and others outside of Wellness Grove that are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to bill for your healthcare and to support the operations of the organization.
Following are examples of the types of uses and disclosures of your protected healthcare information we will make, based on this implied consent. These examples are not meant to be exhaustive but to describe the types of uses and disclosures that may be made by Wellness Grove.
We will use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services. This includes the coordination or management of your healthcare with a third party that has already obtained your permission to have access to your protected health information. For example, we would disclose your protected health information, as necessary, to another healthcare provider who may be treating you. Your protected health information may be provided to a healthcare provider to whom you have been referred to ensure that healthcare provider has the necessary information to diagnose or treat you.
In addition, we may disclose your protected health information from time-to-time to another healthcare provider (e.g., a specialist) who, at the request of your treating provider, becomes involved in your care by providing assistance with your healthcare diagnosis or treatment.
Your protected health information will be used, as needed, to obtain payment for your healthcare services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the healthcare services we recommend for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.
We may use or disclose, as needed, your protected health information in order to support the business activities of Wellness Grove. These activities may include, but are not limited to, quality assessment activities, and staff review activities.
For example, we may disclose your protected health information to interns that see clients at our office. In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your provider. Communications between you and your provider or assistants may be recorded to assist us in accurately capturing your responses; we may also call you by name in the reception area when your provider is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services for the organization). Whenever an arrangement between Wellness Grove and a business associate involves the use or disclosure of your protected health information, we will have a written contract with that business associate that contains terms that will protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your protected health information for other internal marketing activities. For example, your name and address may be used to send you a newsletter about our practice and the services we offer. We may also send you information about products or services that we believe may be beneficial to you. You may contact our Chief Information Officer to request that these materials not be sent to you.
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below.
You may revoke any of these authorizations, at any time, in writing, except to the extent that your provider or Wellness Grove has already taken an action in reliance on the use or disclosure indicated in the authorization.
In the following instance where we may use and disclose your protected health information, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your provider may, using his or her professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your healthcare will be disclosed.
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location or general condition. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare.
We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:
We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.
We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (I) legal process and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on the premises of Wellness Grove, and (6) medical emergency (not on Wellness Grove’s premises) and it is likely that a crime has occurred.
We may disclose your protected health information, as authorized, to comply with workers’ compensation laws and other similar legally-established programs.
Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that your provider and Wellness Grove uses for making decisions about you.
Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information complied in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewed. In some circumstances, you may have a right to have this decision reviewed. Please contact our Chief Information Officer, if you have questions about access to your medical record.
This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You have the right to restrict certain disclosures of protected health information to a health plan when you pay out of pocket in full for the healthcare delivered by Wellness Grove. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply.
Your provider is not required to agree to a restriction that you may request. If the clinician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your clinician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your provider.
We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing.
This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Chief Information Officer if you have questions about amending your medical record.
This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your care, pursuant to a duly executed authorization or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions, and limits.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
You may complain to Wellness Grove, or the Secretary of Health and Human Services, if you believe your privacy rights have been violated by Wellness Grove. For information regarding how to file a complaint, please visit the following website:
Alternatively, Wellness Grove can provide you with an electronic form in which to file your complaint. You may also file a complaint with us by notifying our Chief Information Officer of your complaint. We will not retaliate against you for filing a complaint.
Our Chief Information Officer is Shaun Swiger. Please contact Wellness Grove at (330) 915-2907 should you have any questions and/or concerns.