HIPAA: Confidentiality & Privacy Notice

This Notice describes FNDATN's privacy practices in connection with identifiable information about your past, present, or future health or condition, the provision of health care to you, or payment for your health care. All such medical information is considered Protected Health Information ("PHI"). FNDATN is obligated to protect the privacy and security of PHI as required under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and its implementing regulations. This Notice also describes the ways in which we may use and disclose PHI about you and your rights and certain obligations we have regarding the use of, disclosure of, and access to your PHI. We are required by law to: (i) make sure that PHI that identifies you is kept private; (ii) give you this Notice of our legal duties and privacy practices with respect to PHI about you; and (iii) follow the terms of the Notice that is currently in effect.

Our Pledge Regarding Your Health Information

FNDATN understands that your PHI and your health are personal. Protecting your PHI is important. We create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements.

How We May Use and Disclose Your PHI

The following categories describe different ways that we may use and disclose PHI. For each category of uses or disclosures, we give some examples. Not every use or disclosure in a category will be listed. Except in specified circumstances we will only use or disclose the minimum necessary PHI to accomplish the intended purpose of the use or disclosure.

For Treatment

We may use your PHI to provide you services. We may disclose your PHI to FNDATN providers, employees, and contractors who are involved in providing your health care.

To Obtain Payment

We may use and disclose your PHI so that the treatment and services you receive from us may be billed and payment may be collected from you, an insurance company or other third party (if FNDATN permits such payment methods). For example, we may need to give your PHI about our treatment plan so your health plan will reimburse us or you for the treatment. We may also tell your health plan about a service you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

For Health Care Operations

We may use and disclose PHI about you for our health care operations. These uses and disclosures are necessary to operate our business and make sure that all of our clients receive quality care. For example, we may use your PHI to review our treatment and services and to evaluate the performance of our team providing you service.

Appointment Reminders

Unless you provide us with alternative instructions, we may telephone or send appointment reminders and other similar material to your home.

Treatment Alternatives

We may use or disclose PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Research

We will not use your PHI for research purposes.

Fundraising/Marketing

We might contact you to raise funds for our business or to raise awareness for issues related to health care. You are entitled to opt out of such contacts.

When Required by Law

We may disclose PHI when required by law such as in cases of suspected abuse, neglect or domestic violence, or in response to a court order.

To Avert Threat to Health or Safety

In order to avoid a serious threat to health or safety, we may disclose PHI as necessary to law enforcement or other persons who can reasonably prevent or lessen the threat of harm.

For Public Health Activities

We may disclose PHI when we are required to collect information about disease or injury, or to report vital statistics to the public health authority.

Decedents

PHI may be disclosed to funeral directors or coroners to enable such persons to perform their duties. Your PHI may also be used or disclosed for cadaver organ, eye, or tissue donation purposes. PHI may be disclosed after fifty (50) years and also to individuals who were involved in your care or payment for your care.

For Specific Government Functions

We may disclose PHI in certain situations: military personnel and veterans, to correctional facilities, government benefit programs, and for national security reasons.

Uses and Disclosures of PHI Requiring Authorization

For uses and disclosures not covered by this Notice or the laws that apply to us will be made only with your written authorization. You may revoke the authorization except to the extent we have taken action in reliance upon the authorization.

Your Rights Regarding Your Protected Health Information

You have the following rights relating to your PHI:

To Request Restrictions on Uses/Disclosures

You have the right to ask that we limit how we use or disclose your PHI. We will consider your request, but are not legally bound to agree to the restriction. To the extent that we do agree to any restrictions on our use/disclosure of your PHI, we will comply with your request unless the information is needed to provide you emergency treatment. We cannot agree to limit uses/disclosures that are required by law. To request restrictions, make your request in writing to FNDATN's Privacy Officer at [email protected].

To Request Confidential Communication

You have the right to request that we communicate with you about your treatment/services in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, discuss your request with your provider.

To Inspect and Request a Copy of your PHI

Unless your access to your records is restricted for clear and documented reasons, you have a right to see your PHI upon written request to FNDATN's Privacy Officer at [email protected]. If we deny your request, we will give you a written reason for the denial and explain any right to have the denial reviewed. If you request a copy of the information, we may charge a reasonable processing fee, depending upon your circumstances. You have the right to choose what portions of your PHI you want copied and to have prior information on the cost of processing. You have the right to request your medical record in an electronic format if available.

To Request an Amendment of Your PHI

If you believe there is a mistake or missing information in our record, you may request that we correct or add to the record. This request must be made in writing to FNDATN's Privacy Officer at [email protected]. We may deny the request if we determine that the record is: (1) correct and complete; (2) not created by us and/or not part of our records; or (3) not permitted to be disclosed. Any denial will state the reason for the denial and explain your rights to have the request and denial, along with any statement in response that you provide, appended to your record. If we approve the request for amendment, we will change the record and so inform you, and inform others that need to know about the change in the record.

To an Accounting of Disclosures

You have the right to request an "Accounting of Disclosures." This is a list of when, to whom, for what purpose, and what content of your PHI has been released other than instances of disclosure: for the treatment, payment, and health care operations; to you; or pursuant to your written authorization. This list will not include any disclosures made for national security purposes, to law enforcement officials or correctional facilities, or disclosures made before April 2003. To request a list, discuss your request with the staff member involved in your treatment.

Other Rights

You have the right to request that any out of pocket payment for health care services or items not be disclosed to your health plan; You have the right to request that your information not be used for any fundraising, marketing, or in exchange for payment; and, You have the right to be notified if any breach of your information occurs.

Protection of Reproductive Health Information

We are committed to protecting the privacy of your reproductive health care. In accordance with federal law, FNDATN will not use or disclose your PHI to investigate, prosecute, or impose liability on any person for the mere act of seeking, obtaining, providing, or facilitating reproductive health care that is lawful under the circumstances in which it is provided. If an outside party requests disclosure of your PHI (such as requests for judicial proceedings or law enforcement), we will require the requester to prove that they are legally permitted to force such disclosure under applicable federal law, including but not limited to requiring them to provide a signed, written attestation. This attestation must confirm that the request is not for a prohibited purpose related to the investigation or prosecution of lawful reproductive health care. We will deny any request that does not meet these federal privacy standards.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with FNDATN by contacting [email protected] or 208.954.2359. All complaints must be submitted in writing. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave SW, Washington D.C. 20201; 1-800-368-1019; or online at https://ocrportal.hhs.gov/ocr/smartscreen/main.jsf. If you request, FNDATN will assist you with writing your complaint. FNDATN's Privacy Officer can be contacted at 208-954-2359 and [email protected]. FNDATN will not retaliate against you for filing a complaint.

Right to Change

We reserve the right to change our privacy practices and the terms of this Notice at any time. A copy of our current Notice is posted at fndatnfunctionalmedicine.com and available at our office.