LifeClinic HIPPA Notice

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice of Privacy Practices (the “Notice”) explains how LifeClinic Physical Therapy & Chiropractic LLC (“LifeClinic” or “we”), and its employees, staff, volunteers, and other personnel who are involved in your care, use information about your medical history and current health conditions, treatment, and status, including information that may identify you and that relates to your past, present, or future physical, medical, or mental condition and medical care and related health care services (your “health information”), and share it with others. The terms of this Notice apply to the health information about you that is created, received, or maintained by LifeClinic. We may use or disclose your health information to carry out treatment, facilitate payment or health care operations, and for other purposes as permitted or required by law and described in this Notice. This Notice describes your rights to access and control your health information.

LifeClinic understands that information about you and your health is personal. LifeClinic is committed to protecting your health information. In order to provide you with quality care and to comply with certain state and federal legal requirements, LifeClinic creates a record of the services you receive at LifeClinic. This Notice applies to all of the records of your care generated by LifeClinic. This Notice will tell you about the ways in which LifeClinic may use and disclose your health information. It also describes your rights and certain obligations LifeClinic has regarding the use and disclosure of your health information. LifeClinic is required by law to: (1) Make sure that health information that identifies you is kept private; (2) Give you this Notice of its legal duties and privacy practices concerning your health information; (3) Follow the terms of the Notice that are currently in effect, and (4) Notify you in case there is an unauthorized use or disclosure of your unsecured health information.

APPLICABLE LAW

LifeClinic follows federal privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA), and applicable state privacy laws. Where state law provides greater privacy protection than HIPAA, LifeClinic will follow the more protective state law. In some states, certain types of health information may be subject to additional restrictions or may require specific written authorization for use or disclosure. LifeClinic strives to maintain policies designed to protect your health information in accordance with all applicable legal requirements.

HOW LIFECLINIC MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
The following categories describe different ways that LifeClinic may use or disclose protected your health information. For each category of uses and disclosures, LifeClinic will explain what is meant and may give some examples. Not every use or disclosure in a category will be listed. However, all of the ways LifeClinic is permitted to use and disclose information will fall within one of the categories.

For Treatment. LifeClinic may use and disclose your health information and share it with other health care professionals who are treating you in order to facilitate and provide treatment of medical or health conditions. For example, a doctor treating you for an injury might ask another doctor about your overall health condition, or LifeClinic might share information about your condition with your pharmacist to assist in providing your medication.

For Research. LifeClinic may disclose your health information to researchers when the information does not directly identify you as the source of the information or when a waiver has been issued by an institutional review board or a privacy board that has reviewed the research proposal and protocols for compliance with standards to ensure the privacy of your health information.

For Payment. LifeClinic may use and disclose your health information so that LifeClinic can get paid for the treatment and services you receive at LifeClinic.

For Health Care Operations. LifeClinic may use and disclose your health information to carry out activities that are necessary for our health care, business, and administrative operations. These uses or disclosures are made for quality of care, compliance activities, administrative purposes, contractual obligations, grievances or lawsuits. For example, LifeClinic may use health information to review treatment and services provided at LifeClinic or to evaluate the performance of its staff and contractors in caring for you.

To Individuals or Family Members Involved in Your Health Care. Unless you object, LifeClinic may disclose your health information to a member of your family, a relative, close friend or any other person that you identify who is involved in your care. LifeClinic may also tell your family or friends, personal representative, or any other person who is responsible for your care, of your location, general condition or death, unless you object.

Emergencies. LifeClinic may disclose your health information to a public or private entity assisting in disaster relief so that your family can be notified about your condition, status, or location. You may object to this disclosure with a written request. However, if you are not available or are unable to agree or object, or in some emergency circumstances, LifeClinic will use its professional judgment to decide whether this disclosure is in your best interest.

As Required By Law. LifeClinic will disclose your health information when required to do so by federal, state or local law.

Workers’ Compensation. LifeClinic may release your health information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

For Public Health Activities. LifeClinic may disclose your health information for public health activities. These purposes generally include the following: (1) To prevent or control disease, injury, or disability; (2) To report deaths; (3) To report abuse or neglect of children, elders, and dependent adults; (4) To report reactions to medications or problems with products; (5) To notify people of recalls of products they may be using; and (6) To notify a person who may have been exposed to a disease or who may be at risk for contracting or spreading a disease or condition.

For Organ and Tissue Donation. If you are an organ donor, LifeClinic may release your health information to organizations that obtain, bank, or transplant organs, eyes, or tissue for the purpose of facilitating an authorized organ or tissue donation and transplantation.

For Health Oversight Activities. LifeClinic may disclose your health information to a health oversight agency for activities authorized by law.

For Lawsuits and Disputes. LifeClinic may disclose your health information in response to a court or administrative order, subpoena, discovery request, or other lawful process, but only when the request satisfies HIPAA and applicable state-law requirements. Some states impose additional conditions on disclosures in response to legal process, and LifeClinic will comply with those requirements.

Disclosure to Law Enforcement. If asked to do so by law enforcement and as authorized or required by law, LifeClinic may release health information: (1) To identify or locate a suspect, fugitive, material witness, or missing person; (2) About a suspected victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; (3) About a death suspected to be the result of criminal conduct; (4) About criminal conduct at LifeClinic; and (5) In case of a medical emergency, to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.

Decedents. LifeClinic may release your health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. LifeClinic may also release your health information to funeral directors. LifeClinic may also release information to any individual known to LifeClinic as a family member, close personal friend of the family, or any other person identified, who was involved in your care or the payment for your care prior to your death, unless you indicate otherwise. Your health information may be used or disclosed to others without your authorization after fifty (50) years from the date of your death.

For Specialized Government Functions. LifeClinic may disclose your health information to authorized federal officials for intelligence, counter-intelligence, and other national security activities.

Information About Inmates/Individuals in Custody. If you are an inmate or under the custody of a law enforcement official, LifeClinic may release your health information to the correctional institution or law enforcement official responsible for you as authorized or required by law.

Disclosure For Threats to Health and Safety. In certain circumstances, LifeClinic may be required to disclose health information to avert a serious threat to your health and safety or the health and safety of another person as required by law enforcement. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.

Marketing. LifeClinic will not release your health information for marketing purposes without an authorization from you. Notwithstanding the foregoing, however, LifeClinic may disclose or use your health information in the context of face-to-face communications with you regarding additional products or services, or when you direct us to coordinate care, activities, or services with our affiliates or third parties on your behalf.

Sale of Health Information.  LifeClinic will not sell your health information without an authorization from you.

Specially Protected Information. Certain types of health information may receive additional protection under federal or state law. This may include, but is not limited to, mental health information, substance use disorder records, HIV/AIDS or communicable disease information, genetic information, and reproductive health information. LifeClinic will use or disclose specially protected information only as permitted by applicable law or with any required specific written authorization. If you have questions about whether your records include specially protected information, please contact the HIPAA Privacy Officer.

Fundraising. LifeClinic may use your demographic information and the dates that you received treatment from LifeClinic in order to contact you for fundraising purposes. You have the right to opt out of receiving any fundraising communications. If you do not want to receive these materials, please contact the HIPAA Privacy Officer at the address listed below.

DATA BREACH NOTIFICATION

LifeClinic will promptly notify you if a data breach occurs that may have compromised the privacy or security of your protected health information. LifeClinic will notify you within the legally required time frame, as required by HIPAA and applicable state law. In most circumstances, LifeClinic will notify you in writing by first-class mail, or by email if you have previously agreed to receive notices electronically and have provided LifeClinic with your current email address. LifeClinic will also notify government agencies, regulators, or other parties as required by law.

YOUR RIGHTS

LifeClinic
Attn: HIPAA Privacy Officer
PO BOX 549
Chanhassen, MN 55317-0459

Fax: 1-952-658-2826
Email: supportteam@lifeclinics.life

Right to Inspect and Copy. With certain exceptions, you have the right to inspect and receive copies of your health information, including an electronic copy if your records are maintained electronically. You may request that LifeClinic direct a copy of your health information to a third party that you designate. LifeClinic may charge a reasonable, cost-based fee for the costs of copying, mailing, or other supplies associated with your request. LifeClinic will act on your request within 30 days, or provide you with a written reason for any delay.

Right to Request Amendment. If you believe that your health information is incorrect or incomplete, you may ask LifeClinic to amend the information. You must submit your request in writing and provide a reason that supports your request. LifeClinic will act on your request within 60 days, and will inform you in writing if your request is denied, including the reason for denial and your right to submit a written statement of disagreement.

Right to an Accounting of Disclosures. You have the right to receive a list of certain disclosures that LifeClinic may have made of your health information for six years prior to the date of your request. The list will include disclosures except for those made for treatment, payment, or health care operations, and certain other disclosures such as those you authorized. LifeClinic will provide one accounting per year for free, but may charge a reasonable, cost-based fee if you request another accounting within 12 months.

Right to Request Restrictions. You have the right to request a restriction or limitation on health information that LifeClinic uses or discloses about you for treatment, payment, or health care operations, and to request a limit on the health information that LifeClinic may disclose to family members or friends involved in your care. LifeClinic is not required to agree to your request, except that LifeClinic must agree to a restriction request if you pay out-of-pocket in full for a service or health care item and request that LifeClinic not share that information with your health plan for purposes of payment or health care operations, unless disclosure is otherwise required by law.

Right to Request Confidential Communications. You have the right to request that LifeClinic communicate with you about your appointments or other matters related to your treatment in a specific way or at a specific location. For example, you can ask that LifeClinic only contact you at work or at a specific address. You must specify how or where you wish to be contacted, and LifeClinic will accommodate all reasonable requests.

Right to Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. LifeClinic will confirm that the person has this authority and can act for you before taking any action.

Right to Receive a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. You may request a copy from the HIPAA Privacy Officer at the address listed above, and LifeClinic will provide you with a paper copy promptly.

CHANGES TO THIS NOTICE
LifeClinic reserves the right to change the terms of this Notice at any time. LifeClinic reserves the right to make the revised or changed Notice effective for health information LifeClinic already has about you as well as any information LifeClinic receives in the future. LifeClinic will post a copy of the current Notice in our office and on our website. The Notice will contain an effective date. The new Notice will be available upon request.

QUESTIONS AND COMPLAINTS
If you have any questions or believe that your privacy rights have been violated, you may contact LifeClinic’s HIPAA Privacy Officer in person or mail a written summary of your concern to the address listed above.

You may also file a written complaint with the Department of Health and Human Services at the following address:

Centralized Case Management Operations

U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201

Toll-free: (800) 368-1019

TDD toll-free: (800) 537-7697

Email: OCRComplaint@hhs.gov

You will not be penalized or retaliated against for filing a complaint.

OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of health information not covered by this Notice or the laws that apply will be made only with your written authorization. Uses and disclosures not described in this Notice will be made only with your authorization. When authorization is required, LifeClinic will obtain a written, electronic, or other legally valid authorization that satisfies applicable federal and state law. Some states require specific content, signatures, dates, expiration periods, or written consent for certain records. In some states, authorizations are generally valid for one year unless the authorization states otherwise or another law provides otherwise. If you provide LifeClinic authorization to use or disclose your health information, you may revoke that authorization in writing at any time. If you revoke your authorization, LifeClinic will stop any further use or disclosure of your health information for the purposes covered by your written authorization, except if LifeClinic has already acted in reliance on your authorization. You understand that LifeClinic is unable to take back any disclosure LifeClinic has already made with your authorization and that LifeClinic is required to retain its records of the care that LifeClinic provided to you.