Notice ofPrivacy Practices
Personally identifiable information about your health, your health care, and your payment for health care is called Protected Health Information. We must safeguard your Protected Health Information and give you this Notice about our privacy practices that explains how, when, and why we may use or disclose your Protected Health Information. Except in the situations set out in this Notice, we must use or disclose only the minimum necessary Protected Health Information to carry out the use or disclosure.
We must follow the practices described in this Notice, but we can change our privacy practices and the terms of this Notice at any time. If we revise this Notice, you may read the new version at www.4elementsmd.com. You may also request a copy by calling us at (860) 469-5646 or by asking for one at your next appointment.
Uses and Disclosures That Do Not Require Your Consent
For treatment purposes
We may disclose your health information to doctors, nurses, and others who provide your health care. For example, your information may be shared with people performing lab work or imaging.
For health care operations
We may use or disclose your health information to perform business functions such as employee evaluations and service improvement. We may disclose your information to students training with us. We may use your information to contact you for appointment reminders or to call you by name when your physician is ready to see you.
When required by law
We may be required to disclose your Protected Health Information to law enforcement officers, courts, or government agencies. For example, we may have to report abuse, neglect, or certain physical injuries.
For public health activities
We may be required to report your health information to government agencies to prevent or control disease or injury. We also may have to report work-related illnesses and injuries to your employer so that your workplace may be monitored for safety.
For health oversight activities
We may be required to disclose your health information to government agencies so that they can monitor or license health care providers such as physicians and nurses.
For activities related to death
We may be required to disclose your health information to coroners, medical examiners, and funeral directors to carry out duties related to your death. We also may disclose your information to those involved with locating, storing, or transplanting donor organs or tissue.
To avert a threat to health or safety
In order to avoid a serious threat to health or safety, we may disclose health information to law enforcement officers or other persons who might prevent or lessen that threat.
For specific government functions
In certain situations, we may disclose health information of military officers and veterans, to correctional facilities, to government benefit programs, and for national security reasons.
For workers' compensation purposes
We may disclose your health information to government authorities under workers' compensation laws.
Uses and Disclosures That Require Your Written Consent
The following uses and disclosures of your Protected Health Information will be made only with your written permission, which you may withdraw at any time.
For research purposes
We may want to use your health information in research studies to serve our patient community. In such cases, we will ask you to complete a form allowing us to use or disclose your information for research purposes. Completion of this form is completely voluntary and will have no effect on your treatment.
For marketing purposes
Without your permission, we will not contact you to urge you to use a particular product or service unless such contact is part of your treatment. Without your permission, we will not sell or otherwise disclose your Protected Health Information to any person or company seeking to market its products or services to you.
For psychotherapy notes
Without your permission, we will not use or disclose notes in which your provider describes or analyzes a counseling session in which you participated, unless the use or disclosure is for on-site student training, required by a court order, or for the sole use of the provider who took the notes.
For any other purposes not described in this Notice
Without your permission, we will not use or disclose your health information under any circumstances not described in this Notice.
Your Rights Regarding Your Protected Health Information
To inspect and request a copy of your Protected Health Information
You may view and obtain a copy of your Protected Health Information in most cases. You may not view or copy psychotherapy notes, information collected for use in a legal or government action, or information which you cannot access by law. If we maintain the requested information electronically, you may request it in electronic format.
To request that we correct your Protected Health Information
If you believe there is a mistake or gap in our file of your health information, you may ask us in writing to correct it. We may deny your request if we find the file is correct and complete, was not created by us, or is not allowed to be disclosed. If we deny your request, we will explain our reasons and your rights to have the request, denial, and your written response added to your file. If we approve your request, we will change the file, report the change to you, and notify others who need to know.
To request a restriction on use or disclosure
You may ask us to limit how we use or disclose your information. We generally do not have to agree to your request, except that we must agree not to send Protected Health Information to a health plan for payment or health care operations purposes if you have paid in full for the related service. If we agree, we will put our agreement in writing and follow it except in emergencies. We cannot limit uses or disclosures required by law.
To request confidential communication methods
You may ask that we contact you at a specific address or in a specific way. We must agree to your request as long as it is reasonably easy for us to accommodate.
To find out what disclosures have been made
You may request a list describing when, to whom, why, and what Protected Health Information has been disclosed during the past three years. We must respond within sixty days. We will only charge you if you request more than one list per year. The list will not include disclosures made to you, for treatment, payment, or health care operations, our patient directory, national security, law enforcement, or certain health oversight activities.
To obtain a paper copy of this Notice
Upon your request, we will provide you a paper copy of this Notice at any time, even if you have agreed to receive it electronically.
Questions, Comments & Complaints
If you have questions about your privacy rights or would like to submit a comment or complaint about our privacy practices, please contact our Privacy Officer in writing:
Attention: Privacy Officer
1300 Sullivan Ave
South Windsor, CT 06074
If you believe your privacy rights have been violated, you should bring this to our attention by sending a letter describing your concern to the address above. You will not be penalized or retaliated against for filing a complaint.
You may also file a complaint directly with the U.S. Department of Health and Human Services, Office for Civil Rights.