Notice of Privacy Practices

Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

• Get a copy of your medical record. You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. We will provide a copy or a summary, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
• Ask us to correct your medical record. You can ask us to correct health information about you that you think is incorrect or incomplete. We may say no, but we'll tell you why in writing within 60 days.
• Request confidential communications. You can ask us to contact you in a specific way (for example, a particular phone number or email) or to send mail to a different address. We will say yes to all reasonable requests.
• Ask us to limit what we use or share. You can ask us not to use or share certain health information for treatment, payment or our operations. We are not required to agree, and we may say no if it would affect your care. If you pay for a service or item out of pocket in full, you can ask us not to share that information with your health insurer for payment or operations. We will say yes unless a law requires us to share it.
• Get a list of those we've shared information with. You can ask for a list (an accounting) of the times we've shared your health information for six years before the date you ask, who we shared it with, and why. It will include all disclosures except those about treatment, payment and health care operations, and certain others (such as any you asked us to make). We'll provide one list a year for free and may charge a reasonable, cost-based fee for another within 12 months.
• Get a copy of this notice. You can ask for a paper copy at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney or someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will confirm they have this authority before we take any action.
• File a complaint if you feel your rights are violated. You can complain by contacting us using the information at the end of this notice. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/. We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends or others involved in your care.
• Share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

• Marketing purposes.
• Sale of your information.
• Most sharing of psychotherapy notes.

Our uses and disclosures

We typically use or share your health information in the following ways.

• Treat you. We can use your health information and share it with other professionals who are treating you. Example: your primary care physician or a specialist asks about your Metabolic Snapshot^™ results.
• Run our practice. We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: we use your information to schedule visits and send appointment reminders.
• Bill for your services. We can use and share your health information to bill and get payment. Wellness By Design, MD is a cash-pay practice, but we may provide receipts or records you request for your own reimbursement.
• Work with our business associates. Companies that help us run the practice, such as our electronic health record, scheduling and email systems, may receive health information to do that work. Each signs an agreement requiring it to protect your information.

Other ways we may share

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

• Help with public health and safety issues, such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone's health or safety.
• Do research, when the law allows and appropriate protections are in place.
• Comply with the law, including with the Department of Health and Human Services if it wants to see that we're complying with federal privacy law.
• Respond to organ and tissue donation requests, and work with a medical examiner or funeral director.
• Address workers' compensation, law enforcement and other government requests, such as for workers' compensation claims, law enforcement purposes or with a law enforcement official, health oversight agencies for activities authorized by law, and special government functions such as military, national security and presidential protective services.
• Respond to lawsuits and legal actions, such as in response to a court or administrative order, or in response to a subpoena.

Illinois law

Illinois law gives extra protection to certain types of health information, including mental health records, HIV/AIDS information and genetic testing information. When Illinois law is stricter than federal law, we follow the stricter law, which may mean asking for your specific written permission before sharing.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information, see www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Email and text messages

If you choose to communicate with us by regular email or text message, those messages may not be encrypted. We keep clinical details out of texts and use secure messaging for medical questions. You can ask us to limit or stop email and text communication at any time.

Changes to this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office, and on our website.

Privacy contact

Questions, requests or complaints about your health information:

Privacy Officer: Dr. Tanesha Handy Lloyd
Wellness By Design, MD Ltd.
2551 N. Clark Street, Suite 303, Chicago, IL 60614
[email protected] · (312) 730-7030