Notice of Privacy Practices

1. About This Notice

Rockwell Health Center ("Rockwell," "we," "us," or "our") is required by law to protect the privacy of your protected health information (PHI), to give you this Notice of our legal duties and privacy practices regarding your PHI, and to follow the terms of the Notice currently in effect. Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health and related health care services.

This Notice applies to all of the records of your care generated by Rockwell, whether created by our staff or by other providers involved in your care within our practice. It describes how we may use and disclose your PHI and your rights regarding it.

2. Our Responsibilities

We are required by law to:

• Keep your protected health information private and secure using reasonable administrative, technical, and physical safeguards
• Give you this Notice of our legal duties and privacy practices
• Follow the terms of the Notice that is currently in effect
• Notify you promptly if a breach occurs that may have compromised the privacy or security of your information

We will not use or share your information other than as described here unless you tell us we can in writing. If you give us written permission, you may change your mind at any time by letting us know in writing.

3. How We May Use and Disclose Your Information

The following describes the ways we may use and disclose your protected health information without your written authorization.

For treatment

We use your health information to provide and coordinate your care. For example, your primary care provider and the specialists, therapists, and care team within our practice may share information from your record so that everyone caring for you is working from the same plan.

For payment

We may use and disclose your information to bill and collect payment for the care we provide, for example, to confirm coverage with your health plan or to obtain prior authorization for a service.

For health care operations

We may use and disclose your information to run our practice and improve your care, for example, for quality review, training, care coordination, and administrative functions.

Other permitted uses

• Appointment reminders and health information: to remind you of appointments or to tell you about treatment options or health-related services
• Individuals involved in your care: to share relevant information with a family member, friend, or other person you involve in your care, consistent with your wishes and the law
• As required by law: when federal, state, or local law requires the use or disclosure
• Public health and safety: to prevent or reduce a serious threat to health or safety, to report certain conditions to public health authorities, or to report suspected abuse or neglect as permitted by law
• Health oversight, legal, and government functions: for oversight activities authorized by law, in response to a valid court order or legal process, and for specialized government functions
• Workers' compensation: as authorized by and to the extent necessary to comply with workers' compensation laws

4. Uses That Require Your Authorization

Some uses and disclosures require your written authorization, including most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes, and any sale of your protected health information. Other uses and disclosures not described in this Notice will be made only with your written authorization. If you authorize a use or disclosure, you may revoke that authorization in writing at any time, except to the extent we have already acted in reliance on it.

5. Your Rights

You have the following rights regarding the protected health information we maintain about you:

• Get a copy: You can ask to see or get an electronic or paper copy of your health record. We will provide it, usually within the timeframe required by law, and may charge a reasonable cost-based fee.
• Ask us to correct it: You can ask us to amend information you believe is incorrect or incomplete. We may say no, and if we do we will tell you why in writing.
• Request confidential communications: You can ask us to contact you in a specific way, for example by a particular phone number, or to send mail to a different address. We will accommodate reasonable requests.
• Ask us to limit what we use or share: You can ask us not to use or share certain information. We are not required to agree in every case. If you pay for a service or item in full out of pocket, you can ask us not to share that information with your health plan for payment or operations, and we will agree unless a law requires us to share it.
• Get a list of disclosures: You can ask for an accounting of certain disclosures we made of your information.
• Get a paper 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 if someone is your legal guardian, that person can exercise your rights and make choices about your information.
• Be notified of a breach: You have the right to be notified if a breach occurs that may have compromised the privacy or security of your information.

To exercise any of these rights, please contact us using the information below.

6. Changes to This Notice

We may change this Notice, and the changes will apply to all information we have about you. The new Notice will be available upon request, in our offices, and on this website. We will post the effective date at the top of this page.

7. Complaints

If you believe your privacy rights have been violated, you may file a complaint with our practice by contacting our Privacy Officer at the information below. You may 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 SW, Washington, DC 20201, by calling 1-877-696-6775, or by visiting www.hhs.gov/hipaa/filing-a-complaint.

We will not retaliate against you for filing a complaint.

8. Contact Us

For questions about this Notice, to exercise your rights, or to reach our Privacy Officer [Privacy Officer name and direct contact to be confirmed], please email info@rockwellhc.com or contact either location: