Privacy Practices

NOTICE OF PRIVACY PRACTICES
This notice describes how health information may be used and disclosed and how you can get access to this information. Please review it carefully.

I. Our Pledge Regarding Health Information:

At Mosaic Mind & Body Wellness, we understand that health information about you and your health care is personal. We are committed to protecting the privacy and confidentiality of your health information. We create a record of the care and services you receive from us to provide you with quality care and comply with certain legal requirements. This notice applies to all records of your care generated by our practice.

We are required by law to:

  • Ensure that protected health information (PHI) that identifies you is kept private.

  • Provide you with this notice of our legal duties and privacy practices concerning your health information.

  • Follow the terms of the notice that is currently in effect.

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

II. How We May Use and Disclose Health Information About You:

The following categories describe different ways that we may use and disclose health information. For each category, we will explain what we mean and provide some examples.

For Treatment, Payment, or Health Care Operations:
Federal privacy rules allow health care providers to use or disclose PHI without the patient's written authorization for treatment, payment, or health care operations. For example, we may use and disclose your PHI to consult with another health care provider about your condition to assist in diagnosis and treatment. Disclosures for treatment purposes are not limited to the minimum necessary standard because we need access to the full record to provide quality care.

Lawsuits and Disputes:
If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose health information in response to a subpoena, discovery request, or other lawful processes by someone else involved in the dispute, but only if efforts have been made to inform you about the request or obtain an order protecting the information.

III. Certain Uses and Disclosures Require Your Authorization:

  1. Psychotherapy Notes:
    We keep "psychotherapy notes," and any use or disclosure of these notes requires your authorization unless the use or disclosure is for:

    • Our use in treating you.

    • Our use in training or supervising mental health practitioners.

    • Our defense in legal proceedings instituted by you.

    • Compliance with a legal requirement.

    • Health oversight activities or investigations.

    • Averting a serious threat to health or safety.

  2. Marketing Purposes:
    We will not use or disclose your PHI for marketing purposes.

  3. Sale of PHI:
    We will not sell your PHI.

IV. Certain Uses and Disclosures Do Not Require Your Authorization:

Under certain conditions, we can use and disclose your PHI without your authorization, such as:

  • When required by law.

  • For public health activities.

  • For health oversight activities.

  • For judicial and administrative proceedings.

  • For law enforcement purposes.

  • To coroners or medical examiners.

  • For research purposes.

  • For specialized government functions.

  • For workers' compensation purposes.

  • For appointment reminders and health-related benefits or services.

V. Certain Uses and Disclosures Require You to Have the Opportunity to Object:

  1. Disclosures to Family, Friends, or Others:
    We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. You Have the Following Rights with Respect to Your PHI:

  1. The Right to Request Limits on Uses and Disclosures of Your PHI:
    You have the right to ask us not to use or disclose certain PHI for treatment, payment, or health care operations purposes. We are not required to agree to your request, and we may say “no” if we believe it would affect your health care.

  2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for in Full:
    You have the right to request restrictions on disclosures of your PHI to health plans for payment or health care operations purposes if the PHI pertains solely to a health care item or a health care service that you have paid for out-of-pocket in full.

  3. The Right to Choose How We Send PHI to You:
    You have the right to ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and we will agree to all reasonable requests.

  4. The Right to See and Get Copies of Your PHI:
    Other than “psychotherapy notes,” you have the right to get an electronic or paper copy of your medical record and other information that we have about you. We will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request, and we may charge a reasonable, cost-based fee for doing so.

  5. The Right to Get a List of the Disclosures We Have Made:
    You have the right to request a list of instances in which we have disclosed your PHI for purposes other than treatment, payment, or health care operations, or for which you provided us with an authorization. We will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we may charge you a reasonable cost-based fee for each additional request.

  6. The Right to Correct or Update Your PHI:
    If you believe that there is a mistake in your PHI or that a piece of important information is missing from your PHI, you have the right to request that we correct the existing information or add the missing information. We may say “no” to your request, but we will tell you why in writing within 60 days of receiving your request.

  7. The Right to Get a Paper or Electronic Copy of this Notice:
    You have the right to get a paper copy of this notice, and you have the right to get a copy of this notice by email. And, even if you have agreed to receive this notice via email, you also have the right to request a paper copy of it.

EFFECTIVE DATE OF THIS NOTICE
This notice went into effect on April 27th, 2024.

Acknowledgment of Receipt of Privacy Notice
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information.