Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can obtain access to it. Please review it carefully.

Your Rights

Subject to applicable law, you may ask to inspect or obtain a paper or electronic copy of your medical record; ask us to correct information you believe is incorrect or incomplete; request confidential communications; ask us to limit certain uses or disclosures; request an accounting of certain disclosures; obtain a paper copy of this notice; choose an authorized person to act for you; and file a complaint if you believe your privacy rights have been violated.

If you pay for a healthcare item or service out of pocket in full, you may ask us not to disclose information about that item or service to your health plan for payment or healthcare operations. We will honor the request unless disclosure is required by law.

Your Choices

For certain health information, you may tell us your choices about what we share, including some communications with family or others involved in your care and certain marketing activities. Uses and disclosures requiring an authorization will not be made without your written authorization, and you may revoke an authorization in writing as permitted by law.

How We May Use and Share Your Information

We may use and disclose your protected health information as permitted or required by law, including for treatment, payment, healthcare operations, public health and safety activities, health oversight, workers' compensation, certain law-enforcement purposes, responding to lawsuits or legal proceedings, and other purposes permitted or required by HIPAA and applicable law.

Substance Use Disorder Records

Where Ivy & Oak Health creates, receives, or maintains records subject to 42 CFR Part 2, those records receive the additional protections required by applicable federal law. Uses and disclosures of Part 2 records will be made only as permitted by law and applicable consent requirements.

Our Responsibilities

We are required by law to maintain the privacy and security of protected health information, provide you with this notice of our legal duties and privacy practices, follow the notice currently in effect, and notify affected individuals as required if a breach compromises unsecured protected health information.

We will not use or disclose your information other than as described in this notice or otherwise permitted by law unless you authorize us in writing. You may revoke a written authorization as permitted by law.

Complaints

You may complain to Ivy & Oak Health if you believe your privacy rights have been violated. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.

Changes to This Notice

We may change this notice and make the revised notice effective for information we already maintain as well as information we receive in the future. The current notice will be available on our website and upon request.

Privacy Contact

Mandy Iverson, RN, MSN, MBA, FNP-C — Privacy Officer
Email: [email protected]
Phone: [ADD PATIENT-FACING PHONE NUMBER]
Mailing address: [ADD PRACTICE MAILING ADDRESS]

Important: Complete the phone number and mailing address and have this Notice reviewed against Ivy & Oak Health's actual workflows and applicable state law before publication.