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 to do, and we will follow your instructions.
In these circumstances, you have both the right and choice to tell us to:
- Share your information with your family, close friends, or others involved in your care;
- Share information in a disaster relief situation;
- Include your information in a hospital directory; and/or
If you are unable to tell us your preference, we may 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 and safety.
In these circumstances we never share your information unless you give us written permission:
- Marketing purposes;
- Sale of your information; and
- Sharing of psychotherapy notes
In the circumstance of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures:
How do we typically use or share your health information?
We typically use or share your health information in the following ways:
- Example: A doctor treating you sends us information about your diagnosis and treatment plan so we can arrange additional services.
- Example: We use health information about you to develop better services for you.
- Example: We share information about you with your dental plan to coordinate payment for your dental work.
- Example: Your company contracts with us to provide a health plan, and we provide your company with certain statistics to explain the premiums we charge.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We must meet many conditions in the law before we can share your information for these purposes.
1. Help with public health and safety issues – We can share health information about you for certain situations, such as preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
2. Do research – We can use or share your information for health research.
3. Comply with the law – We will share information about you if state or federal laws so require, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy law.
4. Respond to organ and tissue donation requests and work with a medical examiner or funeral director – We can share health information about you with organ procurement organizations, and can share health information with a coroner, medical examiner, or funeral director when an individual dies.
5. Address workers’ compensation, law enforcement, and other government requests – We can use or share health information about you: for workers’ compensation claims, for law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and for special government functions such as military, national security, and presidential protective services.
6. Respond to lawsuits and legal actions – We can share health information about you in response to a court or administrative order, or in response to a subpoena.
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 we receive your written permission. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information, see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
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: ___________________.
If you have any questions about this notice, please contact us at:
Health and Wellness of Carmel, LLC
Attn: John Compton
11900 N. Pennsylvania Street, Suite 200
Carmel, Indiana 46032
This notice is effective 06/01/2023.
Notice to Patient:
Health and Wellness of Carmel, LLC (the “Practice”) is required to provide you with a copy of our Notice of Privacy Practices, which states how the Practice may use and/or disclose your health information. Please sign this form to acknowledge receipt of the notice. You may refuse to sign this acknowledgement if you wish.