Legal · Notice 04
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. Please review it carefully.
Dr. Amy Seiberlich, ND, operating as Dr. Amy Seiberlich LLC (“the Practice,” “we,” or “us”), is required by law to maintain the privacy of your Protected Health Information (“PHI”), to provide you with this Notice of our legal duties and privacy practices regarding PHI, and to abide by the terms of the Notice currently in effect.
1. What is Protected Health Information?
PHI is individually identifiable information about your past, present, or future physical or mental health, the health care you receive, or payment for that care. It includes information created or received by the Practice when treating you, billing for services, or operating the Practice.
2. How We May Use and Disclose Your PHI Without Your Written Authorization
Treatment
We may use and disclose your PHI to provide, coordinate, or manage your health care. This includes consulting with, referring to, or receiving information from other health care providers involved in your care — for example, a lab processing your diagnostic panel, a pharmacist filling a prescription, or a specialist to whom you are referred.
Payment
We may use and disclose your PHI to obtain payment for the health care services we provide to you — for example, to invoice you, to verify benefits with an insurance carrier, or to process a payment.
Health Care Operations
We may use and disclose your PHI for routine administrative activities of the Practice — including quality assessment, training, licensing, accounting, and general business management.
Business Associates
We may share PHI with third-party service providers (“Business Associates”) who perform functions on our behalf — for example, our electronic health record system, billing software, or secure-messaging vendor. Each Business Associate signs a written agreement obligating them to safeguard your PHI on the same terms required of the Practice.
Other Permitted or Required Disclosures
We may use or disclose PHI without your authorization when permitted or required by law, including:
- Public health activities (for example, reporting disease, vital statistics, or product safety to authorized public health authorities)
- Reporting suspected abuse, neglect, or domestic violence as required by law
- Health oversight activities by government agencies authorized to monitor the health care system
- Judicial and administrative proceedings, pursuant to a subpoena or court order
- Law enforcement purposes as permitted by law
- Coroners, medical examiners, and funeral directors
- Organ, eye, or tissue donation
- Research authorized by an Institutional Review Board or Privacy Board
- To avert a serious threat to your health or safety or the health or safety of others
- Specialized government functions (military, national security, protective services for the President, correctional institutions)
- Workers’ compensation programs as required by state or federal law
3. Uses and Disclosures That Require Your Written Authorization
Other than the uses and disclosures described above, we will obtain your written authorization before using or disclosing your PHI. In particular, we will obtain your written authorization for:
- Most uses and disclosures of psychotherapy notes
- Uses and disclosures of PHI for marketing purposes
- Any sale of your PHI
You may revoke your authorization in writing at any time, except to the extent that we have already taken action in reliance on it. To revoke an authorization, please send a written request to the contact information below.
4. Your Rights Regarding Your PHI
Right to Inspect and Copy
You have the right to inspect and obtain a copy of the PHI we hold about you, in the form and format you request if it is readily producible. We may charge a reasonable, cost-based fee for copies. We may deny your request in limited circumstances; if we do, you may request a review of our decision.
Right to Request Amendment
If you believe PHI we hold about you is incorrect or incomplete, you have the right to request that we amend it. You must make your request in writing and provide a reason supporting it. We may deny your request in limited circumstances permitted by HIPAA; if we do, we will explain the reason in writing.
Right to an Accounting of Disclosures
You have the right to request a list of certain disclosures of your PHI we have made in the six years prior to your request, excluding disclosures for treatment, payment, health care operations, and certain other purposes.
Right to Request Restrictions
You have the right to request that we restrict the uses or disclosures of your PHI for treatment, payment, or health care operations. We are not required to agree to your request, except where you have paid for a service in full out-of-pocket and request that we not disclose information related to that service to your health plan. We will honor that request unless disclosure is required by law.
Right to Request Confidential Communications
You have the right to request that we communicate with you about health matters in a certain way or at a certain location — for example, by sending mail to a P.O. box rather than your home address. We will accommodate reasonable requests.
Right to a Paper Copy of This Notice
You have the right to a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
Right to Be Notified of a Breach
You have the right to be notified if a breach of your unsecured PHI occurs, as required by law.
Right to Receive a Copy of Your PHI Electronically
If your PHI is maintained in an electronic health record, you have the right to obtain a copy in electronic format, or to direct us to transmit a copy to another person or entity, if that direction is clear, conspicuous, and specific.
5. Our Duties
We are required by law to:
- Maintain the privacy of your PHI
- Provide you with this Notice describing our legal duties and privacy practices regarding PHI
- Notify you following a breach of your unsecured PHI
- Abide by the terms of the Notice currently in effect
6. Changes to This Notice
We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI we maintain. A copy of the current Notice will be posted in the office and on this website. You may obtain a copy of the current Notice from the Practice at any time.
7. Complaints
If you believe your privacy rights have been violated, you may file a complaint with the Practice or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with the Practice, please send a written description of your complaint to the contact below. You will not be retaliated against for filing a complaint.
You may also file a written complaint with the U.S. Department of Health and Human Services, Office for Civil Rights:
Office for Civil Rights, U.S. Department of Health and Human Services
200 Independence Avenue SW, Washington, D.C. 20201
1-800-368-1019 · hhs.gov/ocr
8. Contact
For questions about this Notice, to request a paper copy, to exercise any of your rights, or to file a complaint with the Practice, please contact:
Dr. Amy Seiberlich, ND — Privacy Officer
Dr. Amy Seiberlich LLC
401 Union Ave SE, Olympia, WA 98501
360-209-3143
dramy@dramyseiberlich.com