Notice of Privacy Practices

Mind Body Therapy

Isabel Santos

3429 West Devon Avenue Suite 100D

Chicago, IL 60712

224-412-8157

isabel@mindbodychicago.com

Effective Date of This Notice: 4/1/21

This notice describes how health information may be used and disclosed and how you can get access to this information.
I. Our pledge regarding health information:

We understand that health information about you and your care is personal. We are committed to protecting that information. We create a record of the care and services you receive from us, and we need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all records of your care generated by this mental health care practice.

This notice describes how we may use and disclose your health information and outlines your rights regarding this information, along with our legal obligations.

We are required by law to:

  • Make sure that protected health information (PHI) that identifies you is kept private.
  • Give you this notice of our legal duties and privacy practices with respect to your health information.
  • Follow the terms of the notice currently in effect.

We may change the terms of this notice, and such changes will apply to all information we have about you. A current copy will be available upon request, in our office, and on our website.

II. How we may use and disclose health information about you:

We may use and disclose health information about you in the following ways:

For Treatment, Payment, or Health Care Operations:

Federal privacy rules allow health care providers to use or disclose personal health information without written authorization to carry out treatment, payment, or operations. We may also disclose your information to another provider for their treatment activities.

For example, if one of our clinicians consults with another licensed provider about your condition, we are permitted to share information to support diagnosis and care.

Treatment includes coordination with other providers, consultation, and referrals.

Lawsuits and Disputes:

If you are involved in a legal dispute, we may disclose health information in response to a court or administrative order. We may also disclose information in response to a subpoena or lawful request, provided that reasonable efforts have been made to notify you or obtain a protective order.

III. Certain uses and disclosures require your authorization:

Psychotherapy Notes:

We keep “psychotherapy notes” as defined in HIPAA regulations. These may only be disclosed with your written authorization, except in limited cases such as:

  • Use in your treatment.
  • Training or supervision of mental health professionals.
  • Legal defense in proceedings you initiate.
  • Compliance investigations by the Department of Health and Human Services.
  • As required by law.
  • Coroner requests.
  • To help avert a serious threat to health or safety.

Marketing Purposes:<br>We do not use or disclose PHI for marketing.

Sale of PHI:

We do not sell your PHI.

IV. Certain uses and disclosures do not require your authorization:

We may use or disclose your PHI without your written permission for reasons including:

  • As required by law.
  • For public health activities (e.g., reporting abuse or preventing serious threats).
  • For audits and investigations by oversight agencies.
  • For court orders or administrative requests.
  • For reporting crimes on our premises.
  • To coroners or medical examiners.
  • For research approved by appropriate review processes.
  • For government functions (e.g., national security, military operations).
  • For workers’ compensation claims.
  • To remind you of appointments or inform you of treatment options or health benefits.
V. Certain uses and disclosures require you to have the opportunity to object:

We may share PHI with family, friends, or others involved in your care or payment unless you object. In emergencies, consent may be obtained after the fact.

VI. Your rights regarding your phi:

Request Limits:

You may request restrictions on how we use or share your PHI. We are not required to agree if it may impact your care.

Out-of-Pocket Protections:

You may restrict disclosures to insurance if you pay fully out-of-pocket.

Preferred Communication:

You may request how we contact you (e.g., by phone, mail). We will accommodate reasonable requests.

Access to Records:

You may request to see or get copies of your records (excluding psychotherapy notes), in paper or electronic form, within 30 days. Reasonable copying fees may apply.

Accounting of Disclosures:

You may request a list of certain disclosures made in the past 6 years. We will respond within 60 days. One free list is available per year.

Correction Requests:

You may ask us to correct or add to your PHI. If we deny the request, we will explain why in writing within 60 days.

Copy of This Notice:

You have the right to receive a paper or electronic copy of this Notice at any time, even if you have previously agreed to receive it electronically.