IN ACCORDANCE WITH HIPAA, THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR PROTECTED HEALTH INFORMATION.
PLEASE REVIEW CAREFULLY.
OUR COMMITMENT TO YOUR PRIVACY
Lifespark is dedicated to maintaining the privacy of your protected health information. In conducting our business, we will create records regarding you and the treatment and services we provide you. We are required by law to maintain the confidentiality of health information that identifies you. We are also required by law to provide you with this notice of our legal duties and privacy practices concerning your protected health information. By law, we must follow the terms of the notice of privacy practices that we have in effect at the time.
To summarize, this notice provides you with the following important information:
- How we may use and disclose your protected health information
- Your privacy rights in your protected health information
- Our obligations concerning the use and disclosure of your protected health information
The terms of this notice apply to all records containing your protected health information that are created or retained by our organization. We reserve the right to revise or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of your records our organization has created or maintained in the past, and for any of your records we may create or maintain in the future. Lifespark will post a copy of our most current notice in our offices in a prominent location and provide you with a copy of our most current notice.
IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:
Privacy Officer at 952-345-8770
COMMON USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION:
The following categories describe the different ways in which we may use and disclose your protected health information.
Treatment. Lifespark will use and disclose protected health information to provide or coordinate care. We may disclose information about you to any Lifespark personnel who are involved in your care. For example, your direct care staff may need to share information about your medications with your care manager. Additionally, we may disclose your protected health information to health care providers outside of Lifespark who are providing care to you, such as your physician, therapists, or others.
Payment. Lifespark may use and disclose your protected health information to bill and collect payment for the services and items you may receive from us. For example, we may use and disclose your protected health information to obtain payment from third parties responsible for such costs, such as family members. Also, we may use your protected health information to bill you directly for services and items.
Health Care Operations. Lifespark may use and disclose your protected health information to operate our business. For example, we may use your health information to evaluate the quality of care you receive from us, or to decide if we should recommend a change or modification to your services.
Appointment Reminders. Lifespark may use and disclose your protected health information to contact you and remind you of visits/deliveries.
Health-Related Benefits and Services. Lifespark may use and disclose your protected health information to inform you of health-related benefits or services that may be of interest to you, if the information is relevant to the person’s involvement.
Release of Information to Family/Friends. Lifespark may release your protected health information to a friend or family member that is helping you pay for your health care or assisting in your care.
Disclosures Required by Law. Lifespark will use and disclose your protected health information when we are required to do so by federal, state, or local law.
USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES.
The following categories describe unique scenarios in which we may be required or permitted to use or disclose your protected health information without your authorization. We will use or disclose information in these scenarios in accordance with applicable law. If Minnesota law is more restrictive than federal law regarding release of information without authorization, we will follow the Minnesota law.
Public Health Risks. Our organization may disclose your protected health information to public health authorities that are authorized by law to collect information for the following purposes:
- Maintaining vital records, such as births and deaths
- Reporting suspected or possible child abuse
- Preventing or controlling disease, injury or disability
- Notifying a person regarding potential exposure to a communicable disease
- Notifying a person regarding a potential risk for spreading or contracting a disease or condition
- Reporting reactions to drugs or problems with products or devices
- Notifying individuals if a product or device that may be using has been recalled
- Notifying appropriate government agency (ies) and authority (ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information.
Health Oversight Activities. Lifespark may disclose your protected health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
Lawsuits and Similar Proceedings. If you are involved in a lawsuit or dispute, or if there is a lawsuit or dispute concerning your services, we may disclose information about you in response to a court or administrative order. We may also disclose information about you in response to a subpoena, discover request, or other lawful process from someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may release protected health information if asked to do so by a law enforcement official:
- Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement
- Concerning a death we believe might have resulted from criminal conduct
- Regarding criminal conduct at our offices
- In response to a warrant, summons, court order, subpoena, or similar legal process
- To identify/locate a suspect, material witness, fugitive, or missing person
- In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity of location of the perpetrator)
Serious Threats to Health or Safety. Lifespark may use and disclose your protected health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
Military. Lifespark may disclose your protected health information if you are a member of the U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.
National Security. Lifespark may disclose your protected health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your protected health information to federal officials to protect the President, other officials or foreign heads of state, or to conduct investigations.
Inmates. Lifespark may disclose your protected health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary:
- (a) for the institution to provide health services to you,
- (b) for the safety and security of the institution, and/or
- (c) to protect your health and safety or the health and safety of other individuals.
Workers’ Compensation. Our organization may release your protected health information for workers’ compensation and similar programs.
USES AND DISCLOSURES WITH YOUR AUTHORIZATION
Lifespark will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. You may revoke any authorization you provide to us regarding the use and disclosure of your protected health information at any time in writing. After you revoke your authorization, we will no longer use or disclose your protected health information for the reasons described in the authorization. Note: We are required to retain records of your care. Unless the law provides an exception, Lifespark will not use or disclose any psychotherapy notes about you, or use your protected health information for marketing, or sell your protected health information, without your authorization to do so.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION You have the following rights regarding the protected health information that we maintain about you:
Confidential Communications. You have the right to request that our organization communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than at work. In order to request a type of confidential communication, you must make a written request to the Lifespark Privacy Officer at 5320 W 23rd Street, Suite #130, St. Louis Park, MN 55416. We will agree to your request if it is reasonable.
Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your protected health information for treatment, payment, or health care operations, or that we limit our disclosure of your protected health information to individuals involved in your care or the payment of your care, such as family members and friends. To request a restriction in our use or disclosure of your protected health information, you must make a detailed request including: (a) the information you wish restricted; (b) whether you are requesting to limit our practice’s use, disclosure or both; and (c) to whom you want the limits to apply. If you or someone on your behalf pays for a health care item or service in full, you can request that Lifespark not disclose information about that item or service to your health plan for health payment or health care operations purposes, and we will agree to that restriction (unless the law requires us to make the disclosure). We are not required to agree to other requests; however, if we do not agree, we are bound by our agreement except when otherwise required by law, or in an emergency when the information is necessary to treat you or we terminate the restriction.
Inspection and Copies. You have the right to inspect and obtain a copy of the protected health information that may be used to make decisions about you, including patient medical records and billing record. You must submit your request in writing to our Privacy Officer at 5320 W 23rd Street, Suite #130, St. Louis Park, MN 55416 to inspect and/or obtain a copy of your protected health information. Our organization may charge a fee for the costs of copying, mailing, labor, and supplies associated with your request. Our practice may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Reviews will be conducted by another licensed health care professional, chosen by us.
Amendment. You may ask us to amend your protected health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by Lifespark. Your request for an amendment must be made in writing and submitted to Privacy Officer at 5320 W 23rd Street, Suite #130, St. Louis Park, MN 55416. You must provide us with a reason that supports your request for amendment. Our organization will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is:
- (a) accurate and complete;
- (b) not part of the protected health information kept by or for the organization;
- (c) not part of the protected health information which you would be permitted to inspect and copy;
- (d) and/or not created by our organization, unless the individual or entity that created the information is not available to amend the information.
Accounting of Disclosures. All of our clients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain disclosures our organization has made of your protected health information. To obtain an accounting of disclosures, you must submit your request in writing to Privacy Officer at 5320 W 23rd Street, Suite #130, St. Louis Park, MN 55416. All requests for an “accounting of disclosures” must state a time period which may not be longer than six years and may not include dates before October 1, 2004. The first list you request within a 12-month period is free of charge, but we may charge you for additional lists within the same 12-month period. We will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.
Right to a Paper Copy of This Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice any time. To obtain a copy of this notice, contact our Privacy Officer at (952) 345-8770.
Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of the Department of Health and Human Services. To file a complaint with Lifespark LLC, send your written complaint to Lifespark, Attn: Privacy Officer, 5320 W 23rd Street, Suite #130, St. Louis Park, MN 55416. All complaints must be submitted in writing. Lifespark will not penalize or otherwise take action against you for filing a complaint.