Notice of Privacy Practices 

Wild Wellness Integrative Medicine 

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

The Health Insurance Portability and Accountability Act (HIPAA) establishes national standards to protect individuals’ medical records and other personal health information. It gives patients some control over certain parts of their health information and requires organizations such as Wild Wellness Integrative Medicine to implement certain safeguards and practices to keep each patient’s protected health information (PHI) safe. Wild Wellness Integrative Medicine is required by law to maintain the privacy of PHI, which includes any information that is created or received by Wild Wellness Integrative Medicine that relates to the health or condition of an individual, the provision of healthcare to an individual, or payment for the provision of healthcare to an individual and either identifies the individual or is reasonably believed to provide information that can be used to identify the individual. As a patient of Wild Wellness Integrative Medicine, you have several rights under HIPAA.

Wild Wellness Integrative Medicine’s Notice of Privacy Practices describes how Wild Wellness Integrative Medicine uses and discloses your PHI. This notice also describes the rights you have concerning your PHI. This notice applies to employees, physicians, volunteers, trainees, and other persons whose conduct is under the direct control of Wild Wellness Integrative Medicine, whether or not the person is paid by Wild Wellness Integrative Medicine. Please review this notice carefully. If you have any questions about Wild Wellness Integrative Medicine’s Notice of Privacy Practices or your privacy rights under HIPAA, please feel welcome to contact us at (520) 600–0211 or speak directly with one of your healthcare team members.

How Wild Wellness Integrative Medicine Uses and Discloses Your PHI

Family Members and Others Involved in Your Care

 

Wild Wellness Integrative Medicine may disclose your PHI that is directly relevant to a family member or friend who is involved in your medical care or payment for your medical care. Wild Wellness Integrative Medicine may also disclose your PHI to disaster relief organizations during times of disaster to aid in location of you, your friends, or your family members. If you do not want Wild Wellness Integrative Medicine to disclose your PHI to family members, friends, or others who are involved in your care, please inform one of your healthcare team members.

Treatment 

Wild Wellness Integrative Medicine may use and disclose your PHI to provide, coordinate, or manage your healthcare and related services with healthcare providers, including doctors, nurses, therapists, clinical students, and other professionals involved in your care. Wild Wellness Integrative Medicine may disclose PHI regarding your care to your primary care provider to assist with your treatment and follow-up care. Wild Wellness Integrative Medicine may also use and disclose your PHI to contact you regarding upcoming appointments, to inform you about possible treatment options or alternatives, or to tell you about health-related services available to you.

Payment

Wild Wellness Integrative Medicine may use and disclose your PHI to obtain payment or be reimbursed for provided services, including disclosures to health plans and health insurance companies.

Operations

Wild Wellness Integrative Medicine may use and disclose your PHI to improve the quality of care provided to its patients and to conduct its business management and general administrative activities. Such activities may include internal and external audits, quality assessments, and medical reviews.

Research

Wild Wellness Integrative Medicine may disclose your PHI for research purposes only in accordance with your written authorization, except when otherwise authorized by law.

Required by Law

Wild Wellness Integrative Medicine shall disclose your PHI as required by a federal or state statute, regulation, or court opinion, including mandatory reporting obligations. Such reporting includes information about suspected abuse, abandonment, neglect, exploitation, domestic violence, and workers’ compensation program services.

Wild Wellness Integrative Medicine shall disclose PHI to the United States Department of Health and Human Services (HHS), including the Centers for Medicare and Medicaid Services (CMS) and the Office for Civil Rights (OCR), when HHS requests access to PHI for the purposes of investigating Wild Wellness Integrative Medicine’s compliance with the HIPAA Privacy Rule or when self-reporting is required by law.

Wild Wellness Integrative Medicine shall disclose PHI to the Arizona Department of Health Services, the Arizona Medical Board, the Arizona Naturopathic Medical Board and the Arizona Board of Nursing when such agencies request PHI for the purposes of investigating Wild Wellness Integrative Medicine’s compliance with state and federal laws or when self-reporting is required by law.

Public Health

Wild Wellness Integrative Medicine may disclose your PHI to a public health authority for the purpose of preventing or controlling disease, injury, or disability. Such reporting may include births, deaths, suspected communicable diseases, suspected overdose events, medication and medical product adverse events, and product recall information.

Public Safety

When Wild Wellness Integrative Medicine has a good-faith belief that disclosing your PHI will prevent or lessen a serious and imminent threat to the health or safety of a person or the public, it may disclose your PHI to a person or entity reasonably equipped to lessen or prevent such threat.

Law Enforcement

Wild Wellness Integrative Medicine may disclose a limited amount of PHI to law enforcement officials for specific purposes related to identifying or locating a suspect, fugitive, material witness, or missing person. 

 

Coroners, Medical Examiners, and Funeral Directors

Wild Wellness Integrative Medicine may disclose PHI concerning deceased patients to coroners, medical examiners, and funeral directors for the purposes of identifying a deceased patient, determining a cause of death, or for other purposes related to coroner, medical examiner, or funeral director duties.

Organ and Tissue Donation

Wild Wellness Integrative Medicine may use and disclose PHI as necessary for organ, eye, or tissue donation and procurement, processing, distributing, or using a human body or body parts for use in medical education, therapy, or transplantation.

Military, Veterans, National Security, and Other Government Purposes

Wild Wellness Integrative Medicine may disclose the PHI of a member of the United States Armed Forces to a United States Armed Forces official upon written request. Wild Wellness Integrative Medicine may disclose PHI to a federal official representing the interests of a federal agency for the purposes of conducting intelligence, counterintelligence, and other national security activities upon written request.

Judicial Proceedings

Wild Wellness Integrative Medicine may disclose your PHI necessary to comply with a court order or court-ordered warrant, a subpoena or summons issued by a judicial officer, or a grand jury subpoena, provided the court has appropriate jurisdiction over Wild Wellness Integrative Medicine. As allowed by law, Wild Wellness Integrative Medicine will make reasonable efforts to notify you about the request, so that you have an opportunity to object to the disclosure.

Fundraising

Wild Wellness Integrative Medicine may use limited PHI to conduct fundraising activities, provided you have not opted out of receiving fundraising solicitations and communications.

Information with Additional Protection

Certain types of medical information have additional protection under state or federal law. For instance, medical information about communicable diseases and HIV/AIDS, drug and alcohol-abuse treatment, genetic testing, and court-ordered mental evaluation is treated differently from other types of medical information. For those types of information, Wild Wellness Integrative Medicine is required in most circumstances to obtain your permission before disclosing the information to others.

Other Uses and Disclosures

Wild Wellness Integrative Medicine will obtain your authorization to use or disclose your PHI in the following circumstances: (1) disclosures for certain types of mental health records or substance abuse records (2) certain types of disclosures containing certain communicable disease information, including HIV or AIDS-related information (3) disclosures containing information related to genetic testing, and (4) disclosures for marketing purposes.

If you grant your authorization to Wild Wellness Integrative Medicine for a certain type of disclosure, you may end that authorization at any time unless Wild Wellness Integrative Medicine has already relied on your authorization to use or disclose the information. If you would like to revoke your authorization, please submit the request in writing to the Wild Wellness Integrative Medicine Health Information Management Department at Wild Wellness Integrative Medicine, 437 W. Thurber St. #3, Tucson, AZ, 85705.

Privacy Breach Notification

In accordance with Breach Notification for Unsecured Protected Health Information requirements, as outlined in the Health Information Technology for Economic and Clinical Health (HITECH) Act, Wild Wellness Integrative Medicine is required by law to provide notification to affected individuals or their representatives.

Your Rights

Right to Receive a Notice of Privacy Practices

You may download a copy of the current Wild Wellness Integrative Medicine Notice of Privacy Practices from Wild Wellness Integrative Medicine’s website at www.wild-wellness.com, or you may obtain a paper copy of the current Wild Wellness Integrative Medicine Notice of Privacy Practices at any Wild Wellness Integrative Medicine facility.

Right to Access PHI

You have the right to access the PHI about you that is maintained by Wild Wellness Integrative Medicine. This includes the right to inspect or obtain a copy, or both, of the PHI as well as the right to direct Wild Wellness Integrative Medicine to transmit a copy to a designated person or entity of your choice. You may be charged a reasonable, cost-based fee for physical copies of your PHI.

 

Right to Request Amendment of PHI

You have the right to request an amendment or correction of your PHI maintained by Wild Wellness Integrative Medicine if you feel that the information is incomplete or inaccurate. You also have the right to have this request and any decision related to this request included in your record if you so choose. Wild Wellness Integrative Medicine must review your request and is required to respond to your request in writing. If you disagree with Wild Wellness Integrative Medicine’s decision, you have the right to appeal the decision.

Right to Request Restriction of Use and Disclosure of PHI

You have the right to request that Wild Wellness Integrative Medicine restrict the use and disclosure of your PHI maintained by Wild Wellness Integrative Medicine. Such a request must be made in writing. While Wild Wellness Integrative Medicine will make efforts to accommodate such requests, granting such restrictions is not always possible. Upon request, Wild Wellness Integrative Medicine will restrict the information disclosed to your health plan if you have already fully paid for the service.

Right to Receive Confidential Communications by Alternative Means

You have the right to designate a specific means by which you will receive confidential communications from Wild Wellness Integrative Medicine. This may include specifying a single address or phone number where Wild Wellness Integrative Medicine may send information about your healthcare, payment for your healthcare, and related service information.

Changes to This Notice

Wild Wellness Integrative Medicine may change practices concerning the use or disclosure of PHI or implementation of patient rights. Wild Wellness Integrative Medicine reserves the right to change this Notice and to make the revisions effective for all PHI maintained. If Wild Wellness Integrative Medicine changes this Notice, the revised Wild Wellness Integrative Medicine Notice of Privacy Practices will be posted on Wild Wellness Integrative Medicine’s website, www.wild-wellness.com, and at all Wild Wellness Integrative Medicine facilities.

Any revisions of the Wild Wellness Integrative Medicine Notice of Privacy Practices by patients or their representatives, including but not limited to strikeouts, insertions, and deletions, shall not be permitted, and Wild Wellness Integrative Medicine may refuse to provide treatment under such circumstances.

Contact Information

Wild Wellness Integrative Medicine is required by law to provide this notice to you and to follow terms of the notice that are currently in effect.

If you have concerns about this notice or need clarification regarding this notice or any other aspect of your Wild Wellness Integrative Medicine care, please notify your healthcare providers or other healthcare team members. If you are not comfortable discussing your concerns with your healthcare providers or other healthcare team members, please request to speak with a manager or director. You may contact the Wild Wellness Integrative Medicine Corporate Manager at (520) 600–0211 or docjoshreilly@wild-wellness.com.

Wild Wellness Integrative Medicine honors a patient’s right to file a complaint or grievance as well as the patient’s right to a prompt resolution of complaints and grievances. The Wild Wellness Integrative Medicine is available to assist you with concerns related to your Wild Wellness Integrative Medicine care. You have the right to report a complaint or grievance to the Wild Wellness Integrative Medicine Corporate Manager; the Wild Wellness Integrative Medicine Corporate Manager can be reached at (520) 600–0211 or docjoshreilly@wild-wellness.com.

Wild Wellness Integrative Medicine acknowledges a patient’s right to file a privacy-related complaint with the Arizona Department of Health Services Bureau Chief, 150 N. 18th Ave., #450, Phoenix, Arizona, 85007 (phone: 602–364-3030), or with the federal government via the Office for Civil Rights, Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C., 20201, in addition to, or instead of, contacting the Wild Wellness Integrative Medicine Corporate Manager.

Wild Wellness Integrative Medicine shall not retaliate against you or your representatives for filing a complaint or grievance with Wild Wellness Integrative Medicine or any other agency. Additionally, your care will not be affected by the filing of a complaint or grievance with Wild Wellness Integrative Medicine or any other agency.

Effective date: January 1, 2019

JOSHUA REILLY, N.D.

PHONE: 520–600–0211

FAX: 520–600–0212

437 W. Thurber Rd., Suite #3

Tucson, Arizona 85705

USA

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