HIPAA Notice of Privacy Practices

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NOTICE OF PRIVACY PRACTICES – Center for Wellness International

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Effective Date: June 3, 2025

Our Commitment to Your Privacy

The Center for Wellness International (“we,” “us,” or “our”) is dedicated to maintaining the privacy of your Protected Health Information (PHI). PHI is information that may identify you and that relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or the past, present, or future payment for the provision of health care to you. We are required by law to maintain the privacy of your PHI and to provide you with this Notice of our legal duties and privacy practices with respect to PHI. We are obligated to abide by the terms of this Notice currently in effect.

Who This Notice Applies To

This Notice applies to all PHI created or received by the Center for Wellness International, including by our therapists, staff, trainees, and other personnel.

How We May Use and Disclose Your Protected Health Information (PHI)

The following categories describe different ways that we may use and disclose your PHI without your written authorization. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of these categories.

  1. For Treatment: We may use and disclose your PHI to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we may disclose PHI to your primary care physician or another mental health professional to ensure they have the necessary information to diagnose or treat you.
  2. For Payment: We may use and disclose your PHI to obtain payment for the health care services we provide to you. For example, we may need to give your health insurance plan information about the services you received so your health plan will pay us or reimburse you for the services. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
  3. For Health Care Operations: We may use and disclose your PHI for our health care operations. These uses and disclosures are necessary to run our practice and make sure that all of our clients receive quality care. For example, we may use PHI for:
    • Quality assessment and improvement activities.
    • Training programs for students, trainees, or practitioners.
    • Accreditation, certification, licensing, or credentialing activities.
    • Business planning and development, such as cost-management analyses.
    • Business management and general administrative activities, including management activities related to privacy.
    • Resolving internal grievances.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object

We may use or disclose your PHI in the following situations without your authorization or opportunity to object:

  • As Required By Law: We will disclose PHI about you when required to do so by federal, state, or local law.
  • Public Health Activities: We may disclose your PHI for public health activities, such as to a public health authority authorized to collect or receive PHI for the purpose of preventing or controlling disease, injury, or disability; to report births and deaths; to report child abuse or neglect; to report reactions to medications or problems with products.
  • Health Oversight Activities: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, and licensure.
  • Abuse or Neglect: We may disclose your PHI to a public health authority authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe you have been a victim of abuse, neglect, or domestic violence to the governmental entity or agency authorized to receive such information.
  • Legal Proceedings: We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), or in certain conditions in response to a subpoena, discovery request, or other lawful process.
  • Law Enforcement: We may disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. These purposes include: (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on our premises, and (6) medical emergency (not on our premises) and it is likely that a crime has occurred.
  • Coroners, Medical Examiners, and Funeral Directors: We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death, or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose PHI to funeral directors as necessary to carry out their duties.
  • To Avert a Serious Threat to Health or Safety: We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
  • Specialized Government Functions: When the appropriate conditions apply, we may use or disclose PHI of military personnel and veterans for activities deemed necessary by appropriate military command authorities. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities.
  • Workers’ Compensation: We may disclose your PHI as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs established by law.

Uses and Disclosures of PHI Based Upon Your Written Authorization

Other uses and disclosures of your PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. Most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing purposes, and disclosures that constitute a sale of PHI require your authorization. You may revoke this authorization at any time, in writing, except to the extent that we have already taken action in reliance on your authorization.

Your Rights Regarding Your Protected Health Information (PHI)

You have the following rights regarding PHI we maintain about you:

  1. Right to Inspect and Copy: You have the right to inspect and obtain a copy of PHI that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes in most cases. To inspect and copy PHI, you must submit your request in writing to our Privacy Officer. If you request a copy of the information, we may charge a reasonable, cost-based fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request in certain limited circumstances. If you are denied access, you may request that the denial be reviewed.
  2. Right to Amend: If you feel that PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. You must provide a reason that supports your request. We may deny your request if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
    • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
    • Is not part of the PHI kept by or for us;
    • Is not part of the information which you would be permitted to inspect and copy; or
    • Is accurate and complete.
  3. Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of certain disclosures we made of your PHI for purposes other than treatment, payment, or health care operations, and for which you did not provide an authorization. To request this list, you must submit your request in writing to our Privacy Officer. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list.
  4. Right to Request Restrictions: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request, except if the disclosure is to a health plan for purposes of carrying out payment or health care operations (and is not for purposes of carrying out treatment) and the PHI pertains solely to a health care item or service for which you, or a person on your behalf (other than the health plan), has paid us in full. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to our Privacy Officer.
  5. Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests.
  6. Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy. You may obtain a copy of this Notice at our website (www.centerforwellnessint.com) or by requesting a copy from our Privacy Officer.
  7. Right to Be Notified of a Breach: You have the right to be notified following a breach of your unsecured PHI.

Changes to This Notice

We reserve the right to change this Notice and our privacy practices. We reserve the right to make the revised or changed Notice effective for PHI we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in our office and on our website. The Notice will contain the effective date.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services. To file a complaint with us, please contact our Privacy Officer at the address and number below. All complaints must be submitted in writing.

You will not be penalized or retaliated against for filing a complaint.

Contact Information

If you have any questions about this Notice or wish to exercise any of your rights, please contact:

Privacy Officer Center for Wellness International [Insert Physical Address] [Insert Phone Number] [Insert Email Address for Privacy Inquiries]

Note to the Center for Wellness International:

  • Fill in the bracketed information (Physical Address, Phone Number, Email Address for Privacy Inquiries).
  • Designate a Privacy Officer: This individual is responsible for overseeing HIPAA compliance and handling privacy-related inquiries and complaints. This should be the same person designated in your other policies.
  • Review with Legal Counsel: This template provides a general framework for an NPP. It is crucial to have it reviewed by an attorney specializing in healthcare law and HIPAA in North Carolina to ensure it is fully compliant with all federal and state regulations and accurately reflects your specific practices.
  • Distribution: This Notice must be provided to each client no later than the date of the first service delivery (or posted in a clear and prominent location if you only have indirect treatment relationships). You must make a good faith effort to obtain a written acknowledgment of receipt from clients.
  • Website Posting: If you have a website, this Notice must be posted there.
  • Staff Training: Ensure your staff are trained on HIPAA privacy and security rules and understand the contents of this Notice.