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

Effective December 1, 2021

The privacy of your medical information is important to us. You may be aware that the U.S. Government regulations established a privacy rule (HIPAA) governing protected health information. This notice tells you about how it may be used, and about certain rights that you have.

Use and disclosure of protected information.

Federal law provides that we may use your medical information (protected health information) for treatment of you, without further specific notice to you, or written authorization for you. For example, if we refer you to a specialist, we may provide laboratory or test data to that specialist.

Federal law provides that we may use your medical information to obtain payment for our service without further specific notice to you, or written authorization by you. For example, under your health plan, we are required to provide them with a diagnosis code for your visit and a description of the services rendered.

Federal law provides that we may use your medical information for healthcare operations without further specific notice to you, or written authorization by you. For example, our accountants may see your name, dates of treatment, and procedure codes during audits of our books or we may use your information for financial services, quality assurance, risk education and claim management purposes with our medical professional liability insurer.

We may use or disclosure medical information, without further notice to you, or specific authorization by you, where:

• Required by law;

• Required for public health purposes;

• Required by law to report child abuse;

• Required by health oversight agency for oversight activities by law, such as the Department of Health, Office of Professional Discipline or Office of Professional Medical Conduct or Naturopathic Medical Board;

• Required by law in judicial or administrative proceedings; 

• Required by law enforcement purposes by law enforcement officials; 

• Required by a coroner or medical examiner;

• Permitted by law to a funeral director;

• Permitted by law for organ donation purposes;

• Permitted by law to avert a serious threat to health or safety;

• Permitted by law and required by military authorities if you were a member of the U.S. Armed Forces;

We will continue to follow Arizona State law with respect to information regarding HIV/AIDs.

We may contact you by mail or phone, at your residence, to remind you of appointments or to provide information about treatment alternatives. Unless you instruct us otherwise, we may leave a message for you or any answering device or with any person who answers the phone at your residence. 

You can make reasonable requests in writing for us 2 to use alternative methods of communicating with you in a confidential manner. 

Other uses of disclosures of your medical information will be made only with your written authorization. You have the right to revoke any written authorization that you give.

Rights that you have

You have the right to request restrictions (45 CFR 164.522) uncertain of the uses or disclosures above. Except as stated below, we are not required to agree to such restrictions.

 Although your health record is the property of Wild Wellness Integrative Medicine, the information belongs to you. You have the right to inspect the information (a reasonable fee will be charged) under the supervision of a member of the Wild Wellness staff. You have the right to obtain copies of your medical information (a reasonable fee will be charged) (45 CFR 164.522 and 45 CFR 164.524). You have the right to amend the health record as provided in 45 CFR 164.528.

You have the right to request a summary of any disclosures we make of your medical information, except for: disclosures we make to you, or to carry out treatment, payment or healthcare operations, or as requested by your written authorization, or as permitted or required under 45 CFR 164. 502, or for emergency or notification purposes, or for national security or intelligence purposes as permitted by ,law, or to correctional facilities or law enforcement officials as permitted by law, or for public health purposes after being de-identified or limited to remove personally identifiable information, or disclosures made before December 1, 2021.  

Obligations that we have

We are required by law to maintain the privacy of protected health information and to provide individuals with notice of our legal duties and privacy practices. We provide training to our employees to enforce and comply with the above law. 

We are required to abide by the terms of this notice as long as it currently is in effect. 

We reserve the right to revise this notice and to make a new notice effective for all protected health information we maintain. Any revised notice will be posted in our office and copies will be available there. 

If you believe your privacy rights have been violated, you have the right to file a complaint with the secretary of the Department of Health and Human Services of the United states. You may also file a complaint, in writing with us. Complaints should be directed to our privacy officer. 

 

The privacy officer is Dr. Joshua Reilly, NMD. If you desire further information or have any questions or concerns, you may contact him at 520-600-0211. 

No retaliatory action will be taken against you for any complaint you may make.