Notice of Privacy Practice

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.

Effective Date: May 19, 2021

This notice summarizes the privacy practices of your ArchWell Health® medical practice (“we”, “our”, “us), and any healthcare components of any current or future hybrid entity under common ownership or control with your medical practice.

The terms “information” or “health information” in this notice include any information we maintain that reasonably can be used to identify you and that relates to your physical or mental health condition, the provision of health care to you, or the payment for such health care.

WE ARE REQUIRED BY LAW

We will comply with the requirements of applicable privacy laws, which require us to:

Protect the privacy of your health information;
Provide you this notice, which explains how we may use information about you and when we can give out or "disclose" that information to others;
Abide by the terms of this notice that are currently in effect;
Notify you in the event of a breach of your health information; and,
Whenever applicable, follow more stringent privacy laws regarding the use or disclosure of your health information.

WHO WILL FOLLOW THIS NOTICE?

This notice applies to your medical practice, which includes:

All workforce members, health care professionals, and other agents of the medical practice,
All other entities, sites, and locations where the health care professionals' practice. In addition, these entities, sites, and locations may share medical information with each other for treatment, payment or operations purposes as described in this notice.

HOW WE USE OR DISCLOSE INFORMATION

Providing health services may requires us to use and disclose health information for your treatment, to bill for your health care and receive payment, and to otherwise operate our business.

Treatment: We may use or disclose health information to aid in your treatment or the coordination of your care. For example, we will use and disclose your information in order to provide and coordinate the care and services you need: for example, prescriptions, X-rays, and lab work.

Payment: We may use or disclose health information to obtain payment for health care services. For example, we may disclose your health information to your health plan in order to obtain payment for the medical services we provide to you.

Health Care Operations: We may use or disclose health information as necessary to operate and manage our business activities related to providing and managing your health care. For example, we might analyze data to determine how we can improve our services.

HOW ELSE CAN WE USE OR SHARE YOUR HEALTH INFORMATION?

We may use or disclose your health information for the following purposes under limited circumstances:

Required by Law: We may disclose information when required to do so by federal, state, and local law. For example, we may disclose health information to the Secretary of the Department of Health and Human Services, if necessary, for the purpose of reviewing our compliance efforts.

To Persons Involved With Your Care: We may use or disclose your health information to a person involved in your care, or who has a legal right to act for you, or who helps pay for your care, such as a family member, if these people need to know this information to help you, and then only to the extent permitted by this notice or law. If you are unavailable or unable to object, we will use our best judgment to decide if the disclosure is in your best interests (e.g., emergency, deceased).

Public Health Activities: We may disclose your health information to public health authorities for purposes such as reporting or preventing disease outbreaks. We may also disclose your information to the Food and Drug Administration (FDA) or persons under the jurisdiction of the FDA for purposes related to safety or quality issues, adverse events, or to facilitate drug recalls.

Reporting Victims of Abuse, Neglect or Domestic Violence: We may disclose your health information to government authorities that are authorized by law to receive such information, including a social service or protective service agency.

Health Oversight Activities: We may disclose your health information to a health oversight agency for activities authorized by law, such as licensure, governmental audits, and fraud and abuse investigations.

Judicial or Administrative Proceedings: We may disclose your health information for judicial, administrative, or other legal proceedings, such as in response to a court order, search warrant or subpoena.

Law Enforcement Purposes: We may disclose your health information to a law enforcement official for purposes such as providing limited information to locate a missing person or report a crime.

To Avoid a Serious Threat to Health or Safety: We may disclose your health information to avoid a serious threat to the health and safety towards you, another person, or the public, by, for example, disclosing information to public health agencies or law enforcement authorities, or in the event of an emergency or natural disaster.

Specialized Government Functions: We may disclose your health information for specialized government functions, such as military and veteran activities, national security and intelligence activities, and the protective services for the President and others.

Workers’ Compensation: We may disclose your health information to your employer and public health authorities as authorized by, or to the extent necessary to comply with, state workers’ compensation laws that govern job-related injuries or illness.

Research Purposes: We may disclose your health information to researchers for purposes such as conducting research related to the evaluation of certain treatments or the prevention of disease or disability, if the research study meets federal privacy law requirements.

To Provide Information Regarding Decedents: We may disclose information to a coroner or medical examiner to identify a deceased person, determine a cause of death, or as authorized by law. We may also disclose information to funeral directors as necessary to carry out their duties.

Organ Procurement Purposes: We may use or disclose information to entities that handle procurement, banking or transplantation of organs, eyes, or tissue to facilitate donation and transplantation.

To Law Enforcement Officials: We may disclose your health information to correctional institutions and law enforcement officials if you are an inmate of a correctional institution or under the custody of a law enforcement official, but only if the disclosure is necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

To Business Associates: We may disclose your health information to business associates such as vendors that perform functions on our behalf or provide us with services, if the information is necessary for such functions or services. Our business associates are required, under contract with us and pursuant to federal law, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract and permitted by law.

Fundraising Purposes: We may use or disclose your demographic information and other limited information, such as dates and where health care was provided, to certain organizations for the purpose of contacting you to raise funds for our organization. If we contact you for fundraising purposes, we will provide you with a clear opportunity to elect not to receive any further fundraising communications.

Appointment Reminders: We may use or disclose health information to send you reminders about your care, such as appointment reminders with providers who provide medical care to you or reminders related to medicines prescribed for you.

De-Identification: We may also de-identify health information in accordance with applicable laws. After that information is de-identified, it is no longer subject to this notice and we may use it for any lawful purpose.

Prescription Refill Reminders and Health-Related Products and Services: We may use or disclose your health information for prescription refill reminders, to tell you about health-related products or services, or to recommend possible treatment alternatives that may be of interest to you

USE AND DISCLOSURES WITH YOUR AUTHORIZATION

Except for uses and disclosures described and limited as set forth in this notice, we will use and disclose your health information only with a written authorization from you. When we receive a valid Authorization, we will only use or disclose health information consistent with such authorization. For example, psychotherapy notes, marketing communications and the sale of health information are unauthorized without your written authorization.

Revoking Authorization: If you provide us with written authorization to use or disclose health information about you, you may revoke that authorization, in writing at any time. Your revocation of authorization must include the date of the revocation and a signature. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization, except to the extent we have already relied on your authorization. Please note that the revocation will not apply to any authorized use or disclosure of your health information that took place before we received your revocation.

YOUR RIGHTS

The following are your rights with respect to your health information:

Your Right to Receive Confidential Communications: You have the right to ask to receive confidential communications of information in a different manner or at a different place; for example, by sending information to a P.O. Box instead of your home address. We will accommodate reasonable requests.

In certain circumstances, we will accept your verbal request to receive confidential communications; however, we may also require you confirm your request in writing. In addition, any request to modify or cancel a previous confidential communication request must be made in writing.

Your Right to Access: You have the right to see and obtain a copy of certain health information we maintain about you such as medical records and billing records. If we maintain a copy of your health information electronically, you will have the right to request that we provide a copy of your health information in an electronic format to you. You can also request that we provide a copy of your information to a third party that you identify. In some cases, you may receive a summary of this health information.

You must make a written request to inspect or obtain a copy your health information or have your information sent to a third party. In certain limited circumstances, we may deny your request to inspect and copy your health information. If we deny your request, you may have the right to have the denial reviewed. We may charge a reasonable fee for any copies.

Your Right to Request Amendments: You have the right to ask to amend certain health information we maintain about you such as medical records and billing records if you believe the information is wrong or incomplete.

Your request must be in writing and provide the reasons for the requested amendment. If we deny your request, you may have a statement of your disagreement added to your health information.

Your Right to Receive an Accounting of Disclosures of Health Information: You have the right to receive an accounting of certain disclosures of your information made by us during the six years prior to your request. This accounting will not include disclosures of information made:

For treatment, payment, and health care operations purposes;
To you or pursuant to your authorization;
To correctional institutions or law enforcement officials; and
Other disclosures for which federal law does not require us to provide an accounting.

Your Right to Restrict Uses and Disclosures: You have the right to ask to restrict uses or disclosures of your information for treatment, payment, or health care operations. You also have the right to ask to restrict disclosures to family members or to others who are involved in your health care or payment for your health care.

We are not required to agree to your request, except to the extent that you request a restriction on disclosures to a health plan or insurer for payment or health care operations purposes and the items or services have been paid for out of pocket in full. However, we can still disclose the information to a health plan or insurer for the purpose of treating you. For requests to restrict your health information for payment or health care operations purposes, please request the restriction prior to receiving services at our facility or medical office where you receive your care.

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say ‘no’ if it would affect your care. We will consider all submitted requests and, if we deny your request, we will notify you in writing.

Your Right to Receive a Paper Copy of This Notice: You may ask for a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

You may also obtain a copy of this notice through the following website: www.archwellhealth.com, or by submitting a written request to the address identified in the Contacting Your Provider section below.

QUESTIONS, COMPLAINTS AND CONTACTS

Contacting Your Provider: If you have any questions about this notice or want information about exercising any of your rights, we ask that you contact us through ArchWell Health at the following address and/or telephone number:

ArchWell Health
Attn: HIPAA Compliance Officer
102 Woodmont Blvd., Suite 600
Nashville, TN 37205
1-888-987-1151

Submitting a Written Request: You can mail your written requests to exercise any of your rights, including modifying or canceling a confidential communication, requesting copies of your records, or requesting amendments to your record, by contacting us through ArchWell Health at the following address:

ArchWell Health
Attn: HIPAA Compliance Officer
102 Woodmont Blvd., Suite 600
Nashville, TN 37205

Filing a Complaint: If you believe your privacy rights have been violated, you may file a complaint with us.

We ask that all complaints be submitted in writing through ArchWell Health at the following address:

ArchWell Health
Attn: HIPAA Compliance Officer
102 Woodmont Blvd., Suite 600
Nashville, TN 37205

You may also notify the Secretary of the U.S. Department of Health and Human Services of your complaint. We will not take any action against you for filing a complaint.

CHANGES TO THIS NOTICE

We reserve the right to change our privacy practices and notice. We reserve the right to make the revised or changed notice effective for all health information we already have about you as well as any information we receive in the future.

If we make a material change to our privacy practices and this notice, we will post a copy of the revised notice:

On the following website archwellhealth.com, and
At all of our physical health care delivery sites.