Privacy Policy

REMMEL WELLNESS CENTER PRIVACY NOTICE TO PATIENTS
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THAT INFORMATION.  PLEASE REVIEW THIS NOTICE CAREFULLY.

POLICY STATEMENT
Remmel Wellness Center (“RWC”) is committed to maintaining the privacy of your protected health information (“PHI”), which includes information about your medical condition and the care and treatment you receive from RWC and other health care providers.  This notice details how your PHI may be used and disclosed to third parties for purposes of your care, payment for your care, health care operations of RWC, and for other purposes permitted or required by law.  This notice also details your rights regarding your PHI.

USE OR DISCLOSURE OF PHI
RWC may use and/or disclose your PHI for purposes related to your care, payment for your care, and health care operations of RWC.  The following are examples of the types of uses and/or disclosures of your PHI that may occur.  These examples are not meant to include all possible types of use and/or disclosure.

1.     CARE – In order to provide care to you, RWC will provide your PHI to those health care professionals, whether on RWC’s staff or not, directly involved in your care so that they may understand your medical condition and needs and provide advice or treatment (e.g., your physician).  For example, your physician may need to know how your condition is responding to treatment provided by RWC.
2.    PAYMENT – In order to get paid for some or all of the health care provided by RWC, RWC may provide your PHI, directly or through a billing service, to appropriate third party payers, pursuant to their billing and payment requirements.  For example, RWC may need to provide your health insurance carrier with information about health care services that you received from RWC so that RWC can be properly reimbursed.
3.    HEALTH CARE OPERATIONS – In order for RWC to operate in accordance with applicable law and insurance requirements and in order for RWC to provide quality and efficient care, it may be necessary for RWC to compile, use and/or disclose your PHI.  For example, RWC may use your PHI in order to evaluate the performance of RWC’s personnel in providing care to you.

AUTHORIZATION NOT REQUIRED
RWC may use and/or disclose your PHI, without a written authorization for you, in the following instances:

1.     DE-IDENTIFIED INFORMATION – Your PHI is altered so that it does not indentify you and, even without your name, cannot be used to identify you.
2.    BUSINESS ASSOCIATE – To a business associate, which is someone who RWC contracts with to provide a service necessary for your treatment, payment for your treatment and/or health care operations (e.g., billing service or transcription service).  RWC will obtain satisfactory written assurance, in accordance with applicable law, that the business associate will appropriately safeguard your PHI.
3.    PERSONAL REPRESENTATIVE – To a person who, under applicable law, has the authority to represent you in making decisions related to your health care.
4.    PUBLIC HEALTH ACTIVITES -     Such activities include, for example, information collected by a public health authority, as authorized by law, to prevent or control disease, injury or disability.  This includes reports of child abuse or neglect.
5.    FEDERAL DRUG ADMINISTRATION – If required by the Food and Drug Administration to report adverse events, product defects or problems or biological product deviations, or to track products, or to enable product recalls, repairs or replacements, or to conduct post marketing surveillance.
6.    ABUSE, NEGLECT OR DOMESTIC VIOLENCE – To a government authority if RWC is required by law to make such disclosure.  If RWC is authorized by law to make such a disclosure, it will do so if it believes that the disclosure is necessary to prevent serious harm or if RWC believes that you have been the victim of abuse, neglect or domestic violence.  Any such disclosure will be made in accordance with the requirements of law, which may also involve notice to you of the disclosure.
7.    HEALTH OVERSIGHT ACTIVITIES – Activities, when required by law, by government agencies involved in oversight activities that relate to the health care system, government benefit programs, government regulatory programs and civil rights law.  Those activities include, for example, criminal investigations, audits, disciplinary actions, or general oversight activities relating to the community’s health care system.
8.    JUDICIAL AND ADMINISTATIVE PROCEEDING – For example, RWC may be required to disclose your PHI in response to a court order or a lawfully issued subpoena.
9.    LAW ENFORCEMENT PURPOSES – In certain instances, your PHI may have to be disclosed to a law enforcement office for law enforcement purposes.  Law enforcement purposes include: (1) complying with a legal process (e.g., subpoena) or as required by law; (2) information for identification and location purposes (e.g., suspect or missing person); (3) information regarding a person who is or is suspected to be a crime victim; (4) in situations where the death of an individual may have resulted in criminal conduct; (5) in the event of a crime occurring on the premises of RWC; and (6) a medical emergency (not on RWC’s premises) has occurred, and it appears that a crime has occurred.
10.    CORONER OR MEDICAL EXAMINER – RWC may disclose your PHI to a coroner or medical examiner for the purpose of identifying you or determining your cause of death, or to a funeral director as permitted by law and as necessary to carry out its duties.
11.    ORGAN, EYE OR TISSUE DONATION – If you are an organ donor, RWC may disclose your PHI to the entity to whom you have agreed to donate your organs.
12.    RESEARCH – If RWC is involved in research activities, your PHI may be used, but such use is subject to numerous government requirements intended to protect the privacy of your PHI such as approval of the research by an institutional review board and the requirement that protocols must be followed.
13.    AVERT A THREAT TO HEALTH OR SAFETY – RWC may disclose your PHI if it believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to an individual who is reasonably able to prevent or lessen the threat.
14.    SPECIALIZED GOVERNEMNT FUNCTIONS – When the appropriate conditions apply, RWC may use PHI of individuals who are Armed Forces personnel: (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veteran Affairs of eligibility for benefits; or (3) to a foreign military authority if you are a member of that foreign military service.  RWC may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities including the provision of protective services to the President or others legally authorized.
15.    INMATES – RWC may disclose your PHI to a correctional institution or a law enforcement official if you are an inmate of that correctional facility and your PHI is necessary to provide care and treatment to you or is necessary for the health and safety of other individuals or inmates.
16.    WORKERS’ COMPENSATION – If you are involved in a Workers’ Compensation claim, RWC may be required to disclose your PHI to an individual or entity that is part of the Workers’ Compensation system.
17.    DISASTER RELIEF EFFORTS – RWC may use or disclose your PHI to a public or private entity authorized to assist in disaster relief efforts.
18.    REQUIRED BY LAW – If otherwise required by law, but such use or disclosure will be made in compliance with the law and limited to the requirements of the law.

AUTHORIZATION
Uses and/or disclosures, other than those described above, will be made only with your written authorization, which you may revoke at any time.

APPOINTMENT REMINDER
RWC may, from time to time, contact you to provide appointment reminders.  The reminder may be in the form of a letter or postcard.  RWC will try to minimize the amount of information contained in the reminder.  RWC may also contact you by phone and, if you are not available, RWC will leave a message for you.

TREATMENT ALTERNATIVES/BENEFITS
The practice may, from time to time, contact you about treatment alternatives, or other health benefits or services that may be of interest to you.

YOUR RIGHTS
You have the right to:

1.     Revoke any authorization, in writing, at any time.  To request a revocation, you must submit a written request to RWC’s Privacy Officer, Erik Remmel c/o RWC.
2.    Request restrictions in certain use and/or disclosure of your PHI as provided by law.  However, RWC is not obligated to agree to any requested restrictions.  To request restrictions, you must submit a written request to Erik Remmel c/o RWC.  In your written request, you must inform RWC of what information you want to limit, whether you want to limit RWC use or disclosure, or both, and to whom you want the limits to apply.  If RWC agrees to your request, RWC will comply with your request unless the information is needed in order to provide you with emergency treatment.
3.    Receive confidential communications of PHI by alternative means or at alternative locations.  You must make your request in writing to Erik Remmel c/o RWC.  The practice will accommodate all reasonable requests.
4.    Inspect and copy your PHI as provided by law.  To inspect and copy your PHI, you must submit a written request to Erik Remmel c/o RWC.  In certain situations that are defined by law, RWC may deny your request, but you will have the right to have the denial reviewed.  RWC can charge you a fee for the cost of copying, mailing or other supplies associated with your request.
5.    Amend your PHI as provided by law.  To request an amendment, you must submit a written request to Erik Remmel c/o RWC.  You must provide a reason that supports your request.  RWC may deny your request if it is not in writing, if you do not provide a reason and support of your request, if the information to be amended was not created by RWC (unless the individual or entity that created the information is no longer available), if the information is not part of your PHI maintained by RWC, if the information is not part of the information you would be permitted to inspect and copy, and/or if the information is accurate and complete.  If you disagree with RWC’s denial, you have the right to submit a written statement of disagreement.
6.    Receive an accounting of disclosures of your PHI as provided by law.  To request an accounting, you must submit a written request to Erik Remmel c/o RWC.  The request must state a time period which may not be longer than six years and may not include the dates before April 14, 2003.  The request should indicate in what form you want the list (such as a paper or electronic copy).  The first list you request within a 12 month period will be free, but RWC may charge you for the cost of providing additional lists in that same 12 month period.  RWC will notify you of the costs involved and you can decide to withdraw or modify your request before any costs are incurred.
7.    Receive a paper copy of this privacy notice from RWC upon request to Erik Remmel.
8.    Complain to RWC, or to the Secretary of Health and Human Services, Office of Civil Rights, Hubert H. Humphrey Building, 200 Independence Avenue, S. W., Room 509F HHH Building, Washington, D.C. 20201.  Or you may contact a regional office of the Office of Civil Rights, which can be found at www.hhs.gov/ocr/regmail.html.  To file a complaint with RWC, you must contact Erik Remmel.  All complaints must be in writing.
9.    To obtain more information on, or have your questions about your rights answered, you may contact Erik Remmel at (727) 525-1141 or via email at Erik@RemmelWellness.com

REMMEL WELLNESS REQUIREMENTS
RWC:

1.     Is required by law to maintain the privacy of your PHI and to provide you with this privacy notice of RWC’s legal duties and privacy practices with respect or your PHI.
2.    Is required to abide by the terms of the privacy notice.
3.    Reserves the right to change the terms of this privacy notice and to make the new privacy notice provisions effective for all of your PHI that it maintains.
4.    Will not retaliate against you for making a complaint.
5.    Must make a good faith effort to obtain from you an acknowledgement of receipt of this notice.
6.    Will post this privacy notice on RWC web site, if RWC maintains a web site.
7.    Will provide this privacy notice to you by email if you so request.  However, you also have the right to obtain a paper copy of this privacy notice.

EFFECTIVE DATE

This notice is effective as of April 14th, 2003.

ACKNOWLEDGEMENT

By clicking the link below you acknowledge that you have read this privacy notice and agree to it's terms.

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