Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. All providers and staff are required by law to maintain the privacy of your Protected Health Information (PHI), including PHI that we keep in electronic form.  “PHI” refers to information in your health record that could identify you. Please review this form carefully.

 

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 an electronic or paper copy of your medical record (1)

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a 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” to your request, 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, home or office phone) 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, etc. We are not required to agree to your request, and we may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all the disclosures except for those about treatment, payment, health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

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. We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

• You can make a complaint if you feel we have violated your rights by contacting us at getintouch@sundewtherapy.com. You can 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.

 

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 described 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

• 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 and psychotherapy notes (2)

You may revoke any such authorization at any time, provided the request is made in writing

There are limits to our confidentiality when you or other persons are in physical danger:

1. If we come to believe that you are threatening serious harm to another person, we are required to try to protect that person.
2. If you seriously threaten or act in a way that is very likely to harm you, I may have to seek a hospital for you or to call on your family members or others who can help to protect you. 
3. In an emergency where your life or health is in danger, and I cannot get your consent, I may give other professionals information to protect your life. 
4. If I believe or suspect that you, or someone else, is abusing a child, an elderly person, or a disabled person I must file a report with a state agency. 
5. Please bear in mind that if you decide to instigate any legal proceedings against us for any reason, we will no longer be able to guarantee confidentiality.

Uses and Disclosures

We may use and share your information as we:

• Occasionally consult with other health and mental health professionals about your case. We make every effort to avoid revealing your identity. These professionals are also legally bound to keep the information confidential.
• Run our organization. We may disclose your PHI to a health oversight agency, such as a government agency, for activities authorized by law, such as for professional licensure. Your PHI may also be used by disclosed individuals or organizations that assist Sundew Therapy and Wellness with our legal obligations. For example, we may disclose information to consultants or attorneys who assist us in our business activities. These business associates are required to protect the confidentiality of your information with administrative, technical, and physical safeguards. 
• Should you elect to use insurance benefits to pay for any applicable services your insurance company has the right to information about your diagnosis, symptoms, history, and substance abuse issues (if any). We can provide no assurance that the confidentiality of your information will be maintained. 
• Comply with the law. We may use or disclose your health information when required by law. If this happens, disclosures will be made in compliance with the law and will be limited to the relevant requirements of the law. Examples include law enforcement reports and abuse/neglect reports, address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions. If you are involved in a court proceeding and there is a request concerning the services provided, we will seek your written authorization prior to disclosing any information. If disclosure is contraindicated, a court order may be needed to protect your records. If you file a worker’s compensation claim, your therapist must make available all mental health information in their possession relevant to that particular injury in the opinion of the Delaware Dept. of Vocational Rehabilitation, to your employer, your representatives, or other state department upon request.

 

How else can we use or share your health information?

We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

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.

Changes to the Terms of 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 upon request, in our office, and on our website.

Last Updated: July 29th, 2023