Notice of Privacy Practices for Coaching Services Whole Parenting Project is dedicated to maintaining your confidentiality and the privacy of your health information. This notice pertains to Coaching clients engaged in services and describes how personal information about your health or substance use may be used, disclosed, and how you can get access to this information. Client Records While conducting business with you, records are created regarding you and the services provided to you. When engaging in Counseling or Coaching services, your record may contain personal information about you and your health. State and federal law protects the confidentiality of this information. “Protected health information” is information about you, including demographic information, that may identify you and relates to your past, present, or future physical or mental health or condition and related health care services. The confidentiality of alcohol and drug abuse client records is specifically protected by federal law and regulations. Whole Parenting Project is required to comply with these additional restrictions. This includes a prohibition, with very few exceptions, on informing anyone outside the services you are engaged in Therapy services and/or disclosing any information that identifies you as an alcohol or drug abuser. The violation of Federal laws or regulations is a crime. If you suspect a violation you may file a report to the appropriate authorities in accordance with federal regulations. How Your Information May be Used and Disclosed: For Treatment or Services. Use of medical and clinical information about you may be used to provide you with treatment or services. For Payment. Your information may be used and disclosed to bill and collect a payment for the services or items provided to you. For Health Care Operations. Use and disclosure of protected health information (“PHI”) for certain purposes in connection with the operation of services. Without Authorization. Applicable law also permits disclosure of information about you without your authorization in a limited number of other situations, such as with a court order. These situations are explained on the following pages. With Authorization.Written authorization must be obtained from you for other uses and disclosures of your PHI. Your Rights Regarding Your Protected Health Information You have the following rights regarding PHI maintained about you: Right of Access to Inspect and Copy. You have the right, which may be restricted in certain circumstances, to inspect and copy PHI that may be used to make decisions about your care. There is a reasonable, cost-based fee for copies. If your records are maintained electronically, you may also request an electronic copy of your PHI. Right to Amend. If you feel that the PHI about you is incorrect or incomplete, you may ask for an amendment to the information although agreement to amend isn’t required. Right to an Accounting of Disclosures. You have the right to request an accounting of the disclosures that is made of your PHI. Right to Request Restrictions. You have the right to request a restriction or limitation on the use or of your PHI for services, payment, or health care operations. Agreement is not required for your request, except in certain limited circumstances. Right to Request Confidential Communication. You have the right to request that communication about medical matters be made in a certain way or at a certain location. Right to a Copy of this Notice. Upon Request, you have the right to a copy of this notice. Confidentiality of Alcohol and Drug Abuse Client Records The confidentiality of alcohol and drug abuse client records is protected by additional federal law and regulations. Evolv and JoAnna Smith Ramos are required to comply with these additional restrictions. This includes a prohibition, with very few exceptions, on informing anyone outside of Evolv that you are involved in services or disclosing any information that identifies you as an alcohol or drug abuser. Some of the exceptions to this general rule include: The disclosure is allowed by a court order. The disclosure is made to medical personnel in a medical emergency. The disclosure is with your written consent. The violation of federal laws or regulations is a crime. If you suspect a violation you may file a report to the appropriate authorities in accordance with federal regulations. How Your Health Information May be Used and Disclosed Listed below are examples of the uses and disclosures that Whole Parenting Project and JoAnna Smith may make of your protected health information (“PHI”). These examples are not meant to be exhaustive. Rather, they describe types of uses and disclosures that may be made. Uses and Disclosures of PHI for Services, Payment, and Business Operations Services. Your PHI may be used and disclosed by your physician, Counselor, Coach, staff, and others outside of Whole Parenting Project that are involved in your care for the purpose of providing, coordinating, or managing your health care and any related services. This includes coordination or management of your care with a third party, consultation with other health care providers, professional Coaches or referral to another provider. For example, your protected health information may be provided to the agency that referred you to Whole Parenting Project to ensure that you have the best opportunity for success. In addition, disclose of your protected health information may be made from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of Whole Parenting Project becomes involved in your care. Payment Your PHI will not be used to obtain payment for your health care services without your written authorization. Examples of payment-related activities are: billing you for services and items you receive, making a determination of eligibility or coverage for insurance benefits, processing claims with your insurance company, reviewing services provided to you to determine medical necessity, or undertaking utilization review activities. Business Operations Your PHI may be disclosed, as needed, in order to support the business activities of services including, but not limited to, quality assessment activities, employee review activities, training of students, licensing, and conducting or arranging for other business activities. For example, your name may be called in the waiting room when it is time for your appointment. Your PHI may be shared with third parties that perform various business activities (e.g., billing or typing services) for Whole Parenting Project provided there is a written contract with the business that prohibits it from re-disclosing your PHI and requires it to safeguard the privacy of your PHI. You may be contacted to be reminded of your appointments or to provide information to you about services or other related benefits and services that may be of interest to you. Other Uses and Disclosures That Do Not Require Your Authorization Required by Law. Disclosure of your PHI may be made to the extent that the use or disclosure is required by law, made in compliance with the law, and limited to the relevant requirements of the law. Medical Emergencies. Disclosure or use of your protected health information in a medical emergency situation to medical personnel only. Child Abuse or Neglect. Disclosure of your PHI to a state or local agency that is authorized by law to receive reports of child abuse or neglect, prenatal exposure to controlled substances, including alcohol. However, the information disclosed is limited to only that information which is necessary to make the initial mandated report. Minors. Disclosure may be made to a parent, guardian, or other person authorized under state law to act on behalf of a minor, those facts about a minor which are relevant to reducing a threat to the life or physical wellbeing of the minor or any other individual, if the minor applicant lacks capacity to make a rational decision and the minor’s situation poses a substantial threat to the life or physical wellbeing of the minor or any other individual which may be reduced by communicating relevant facts to such person. Incompetent and Deceased Clients. Disclosure of PHI regarding deceased clients for the purpose of determining the cause of death, in connection with laws requiring the collection of death or other vital statistics, or permitting inquiry into the cause of death. Research. PHI may be disclosed to researchers if (a) an Institutional Review Board reviews and approves the research and a waiver to the authorization requirement; (b) the researchers establish protocols to ensure the privacy of your PHI; (c) the researchers agree to maintain the security of your PHI in accordance with applicable laws and regulations; and (d) the researchers agree not to redisclose your protected health information except back to Whole Parenting Project. Criminal Activity on Premises/Against Personnel. Disclosure may be made of your PHI to law enforcement officials if you have committed a crime during services or against Whole Parenting Project and Coaching staff. Duty to Warn. When it is learned that a client has made a specific threat of serious physical harm to another specific person or the public , and disclosure is otherwise required under statute and/or common law, careful consideration will be given to appropriate options that would permit disclosure. Court Order. Disclosure may be made of your PHI if the court issues an appropriate order and follows required procedures concerning Confidentiality of Alcohol and Drug Abuse Records. Note also that if your records are not actually “records” within the meaning of 42 CFR Part 2, your records may not be subject to the protections of 42 CFR Part 2. Interagency Disclosures. Limited PHI may be disclosed for the purpose of coordinating services among government programs that provide mental health services where those programs have entered into an interagency agreement. Public Safety. Your PHI may be disclosed to avert or lessen a serious threat to health or safety, such as physical or mental injury being inflicted on you, someone else, or the public. Specialized Government Functions. If you are or have been a member of the U.S. Armed Forces, your PHI may be disclosed as required by military command authorities. Disclosure of your PHI may be made to authorize federal officials for national security and intelligence reasons and to the Department of State for medical suitability determinations. Health Oversight. Disclosure of PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information may include government agencies, third-party payors, and peer review organizations performing utilization and quality control. If disclosure of PHI is made to a health oversight agency, an agreement will be in place that requires the agency to safeguard the privacy of your information. Public Health. Use or disclosure of your PHI for public health activities to a public health authority authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or if directed by a public health authority, to a government agency that is collaborating with that public health authority. In certain circumstances outlined in the Privacy Regulations, disclosure of your PHI to a person who is subject to the jurisdiction of the Food and Drug Administration with respect to the reporting of certain occurrences involving food, drugs, or other products distributed by such person. In certain limited circumstances, disclosure of your PHI may be made when a person that may have been exposed to a communicable disease or may otherwise be at risk of spreading or contracting such disease, if such disclosure is authorized by law. For example, disclosure of PHI regarding the fact that you have contracted a certain communicable disease to a public health authority authorized by law to collect or receive such information. Uses and Disclosures of PHI with Your Written Authorization Other uses and disclosures of your PHI will be made only with your written authorization. You may revoke this authorization at any time, unless JoAnna Smith, Whole Parenting Project, or its staff has taken an action in reliance on the authorization of the use or disclosure you permitted. Uses and Disclosures WITHOUT Your Authorization: Protected Health Information NOT in Connection with Drug or Alcohol Abuse Diagnosis, Treatment, Service, or Referral. If you are not applying for or receiving services related to drug or alcohol abuse, the rules governing the use and disclosure of protected health information are different from and less restrictive than the rules governing information involving drug and alcohol diagnosis, treatment and referral. The next section lists the additional allowable disclosures that may be made without your authorization if you are not applying for or receiving services for drug or alcohol abuse. (This list does NOT apply to those persons applying for or receiving services for drug or alcohol abuse): Allowable disclosure when required by law. Disclosure of your PHI as required by state or federal law. 2. Allowable disclosure for health or safety. Disclosure of your protected health information may be made to avert or lessen a serious threat of harm to you, to others, or to the public. 3. Expanded allowable abuse reporting/investigation of abuse. Disclosure of protected health information may be made to a person legally authorized to investigate a report of abuse or neglect. 4. Expanded allowable public health and health oversight activities. Disclosure of your protected health information may be made for public health purposes and health oversight purposes including licensing, auditing or accrediting agencies authorized or allowed by law to collect such information, including, for example, requirement to collect, report or disclose information about disease, injury, vital statistics for public health purposes or other information for investigation, audit or other health oversight purposes. 5. Expanded allowable disclosure for law enforcement activities. Disclosure may be made of protected health information to law enforcement officials in response to a valid court order or warrant or as otherwise required or permitted by law. 6. Expanded allowable disclosure to your legally authorized representative (LAR). Disclosure of your health information to a person appointed by a court to represent or administer your interests. 7. Expanded allowable disclosure in judicial and administrative proceedings. Disclosure of your health information may be made pursuant to a valid court or administrative order, or in some cases, in response to a valid subpoena or discovery request. 8. Allowable disclosure to the Secretary of Health and Human Services. Disclose must be made of your health information to the United States Department of Health and Human Services when requested in order to enforce the privacy laws. Your Rights Regarding your Protected Health Information Your rights with respect to your protected health information are explained below. Any requests with respect to these rights must be in writing. A brief description of how you may exercise these rights is included. You have the right to inspect and copy your Protected Health Information. You may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as the record is maintained. A “designated record set” contains medical and billing records and any other records used for making decisions about you. Your request must be in writing. A reasonable cost-based fee is charged for the copies. If your records are maintained electronically, you may also request an electronic copy of your PHI. You can be denied access to your PHI in certain circumstances. In some of those cases, you will have a right to appeal the denial of access. You may have the right to amend your Protected Health Information. You may request, in writing, that your PHI be amended that has been included in a designated record set. In certain cases, the request for an amendment may be denied. If your request is denied for amendment, you have the right to file a statement of disagreement. A rebuttal may be prepared to your statement and you will be provided with a copy of it. You have the right to receive an accounting of some types of Protected Health Information disclosures. You may request an accounting of disclosures for a period of up to six years, excluding disclosures made to you, made for treatment purposes, or made as a result of your authorization. A reasonable fee may be charged. You have a right to receive a paper copy of this notice upon request. You have the right to request added restrictions on disclosures and uses of your Protected Health Information. You have the right to ask that use or disclosure of any part of your PHI for services, payment, or health care operations not be made to family members involved in your care. Your request for restrictions must be in writing and Whole Parenting Projectis not required to agree to such restrictions, unless the request is to restrict disclosure of PHI to a health plan for purposes of carrying out payment of health care operations, and the PHI pertains to a health care item or services that you paid for out of pocket. In that case, your request will be honored for a restriction. In all other cases, it will be decided whether or not to agree to the restriction. You have a right to request confidential communications. You have the right to request to receive confidential communications by alternative means or at an alternative location. Reasonable, written requests will be accommodated. This accommodation may be conditioned by asking you for information regarding how payment will be handled or specification of an alternative address or other method of contact. You have the right to file a complaint if you believe your privacy rights as a client have been have violated. You may file a complaint in writing to Whole Parenting Projector to the Department of Health & Human Services. The complaint must be filed within 180 days of when you knew or should have known that the act occurred. In addition, if there is a breach of unsecured protected health information concerning you, it may be required to notify you of this breach, including what happened and what you can do to protect yourself. Changes to this Privacy Statement Whole Parenting Project and JoAnna Smith may revise and/or update the Privacy Policy at any time. Your continued usage of services means that you accept those changes. Therefore you should review the Privacy Policy periodically to familiarize yourself with any changes,modifications,updatesandinterpretations. The right to change the terms of Notice of Privacy Practices at anytime is also reserved. Any new Notice of Privacy Practices will be effective for all PHI that are maintained at that time. Revisions to the Notice of Privacy Practices will be made available by sending a copy to you in the mail upon request, or providing one to you at your next appointment. This Notice of Privacy Practices describes use and disclosure of your protected health information (“PHI”) in accordance with all applicable law. It also describes your rights regarding how you may gain access to and control your PHI. Law requires privacy of PHI to be maintained and to provide you with notice of legal duties and privacy practices with respect to PHI. If you have questions regarding the Privacy Policies of Whole Parenting Project you may contact [email protected] or 651-560-6407.