Patient Privacy

Your Rights

You have the right to:

• Get an electronic or paper copy of your health information.
• Ask us to correct or amend health information you believe is wrong or incomplete.
• Request confidential communications and ask us to contact you in a specific way or at a specific place.
• Ask us to limit certain uses or disclosures of your health information.
• Get a list of certain disclosures we have made.
• Get a paper copy of this notice at any time.
• Choose someone to act for you, when that person has legal authority.
• File a complaint if you believe your privacy rights have been violated.

Your Choices

For certain health information, you may tell us your choices about what we share. These choices may include:

• Sharing information with family members, friends, caregivers, or others involved in your care or payment for your care.
• Sharing information in a disaster-relief situation.
• Receiving appointment reminders and other communications by phone, email, text message, or patient portal.

If you are unable to tell us your preference—for example, if you are unconscious—we may share information when we believe it is in your best interest and the law permits it. We may also share information to reduce a serious and imminent threat to health or safety.

We do not sell your protected health information. Most uses and disclosures of psychotherapy notes, uses and disclosures of protected health information for marketing, and disclosures that constitute a sale of protected health information require your written authorization. Other uses and disclosures not described in this notice will be made only with your written authorization. You may revoke an authorization in writing at any time, except to the extent we have already acted in reliance on it.

How We May Use and Disclose Your Health Information

When the HIPAA minimum necessary standard applies, we limit the protected health information we use, disclose, or request to what is reasonably necessary for the purpose. This standard does not apply in circumstances excluded by law, including disclosures to or requests by a health care provider for treatment.

• Treat you. We may use and share your health information to provide, coordinate, or manage your nutrition care and to work with other health professionals involved in your care.
• Run our organization. We may use and share your information to operate our practice, improve care, train and supervise our workforce, manage quality and compliance, and contact you when needed.
• Bill for services and review benefits. We may use and share your information with health plans and others to verify coverage, obtain payment, coordinate benefits, or perform billing and collection activities.
• Work with business associates. We may share information with vendors and service providers that perform functions for us. When required, they sign agreements requiring them to safeguard the information and use it only for permitted purposes.
• Contact you. We may contact you about appointments, care coordination, benefits, services, or treatment alternatives. We may use phone, email, text message, or the patient portal, consistent with your preferences and applicable law.
• Help with public health and safety issues. We may disclose information for public health activities, product recalls, disease prevention, reporting suspected abuse or neglect, and preventing or reducing a serious threat to health or safety.
• Comply with the law. We may disclose information when federal, state, or local law requires it, including to the U.S. Department of Health and Human Services to demonstrate compliance with federal privacy law.
• Respond to organ and tissue donation requests. We may share information with organ-procurement organizations when applicable.
• Work with a medical examiner or funeral director. We may disclose information to a coroner, medical examiner, or funeral director when permitted by law.
• Address workers’ compensation, law enforcement, and government requests. We may disclose information for workers’ compensation claims; certain law-enforcement purposes; health oversight activities; and specialized government functions such as military, national-security, and protective services, as the law allows.
• Respond to lawsuits and legal actions. We may disclose information in response to a valid court or administrative order, subpoena, discovery request, or other lawful process, subject to applicable protections.
• Conduct research. We do not ordinarily use health information for research. If we do, we will obtain your written authorization or follow another process permitted by law, such as approval by a privacy board or institutional review board.

Your Rights in Detail

Get a copy of your health information

You may ask to inspect or receive an electronic or paper copy of health information we maintain about you, such as medical and billing records. We will provide a copy or summary, usually within 30 days, or sooner when applicable state law requires. We may charge a reasonable, cost-based fee where permitted.

For records governed by Washington law, we will respond to a written request within 15 working days. If an unusual delay is permitted, we will explain the reason in writing and give you the earliest date the records will be available, which will not be later than 21 working days after the request.

We may deny a request in limited circumstances. If review of a denial is available, we will tell you how to request it.

Ask us to correct or amend your record

You may ask us in writing to correct health information you believe is wrong or incomplete. We may deny the request in certain circumstances, but we will explain the reason in writing. We usually respond within 60 days, subject to a permitted extension.

Request confidential communications

You may ask us to contact you in a specific way—for example, only at a particular phone number—or to send mail to a different address. We will accommodate reasonable requests. Ordinary email and text messaging can present privacy risks; you may request another method.

Ask us to limit what we use or share

You may ask us not to use or share certain information for treatment, payment, or health care operations. We are not required to agree if the request would affect your care, except as described below. If we agree, we may still use or share the information if it is needed for emergency treatment.

If you pay in full out of pocket for a specific service, you may ask us not to disclose information about that service to your health plan for payment or health care operations. We will agree unless the law requires the disclosure.

Get a list of disclosures

You may ask for an accounting of certain disclosures of your health information made during the six years before your request. The accounting does not include every disclosure, such as most disclosures for treatment, payment, or health care operations. We will provide one accounting in a 12-month period at no charge and may charge a reasonable, cost-based fee for additional requests.

Get a copy of this notice

You may ask for a paper copy of this notice at any time, even if you agreed to receive it electronically. The current notice will also be available on our website.

Choose someone to act for you

If you have given someone medical power of attorney, or if someone is your legal guardian or otherwise legally authorized to act for you, that person may exercise your rights and make choices about your health information. We may verify the person’s authority before taking action.

More Protective State Laws

HIPAA is a federal privacy standard. When another applicable law gives you greater privacy protection or greater rights, we will follow that more protective law. The rules that apply can depend on the type of information, the service provided, your age, and the state in which you receive care.

Washington

Washington law provides additional protections for certain health care information and services, including mental health information, sexually transmitted infection and HIV information, reproductive and sexual health information, genetic information, and confidential services provided to minors, when applicable. Washington also provides the shorter record-access response period described in the ‘Your Rights in Detail’ section. We will obtain authorization or otherwise limit disclosures when Washington law requires.

Idaho

We will comply with applicable Idaho laws that give additional protections to particular records or patients, including protections that may apply to minors and specially protected health information. When Idaho law is more protective than HIPAA, the Idaho rule will govern.

Oregon

Oregon law may provide additional confidentiality and authorization protections for genetic information and certain mental health, substance use disorder, HIV or sexually transmitted infection, and minor health records. We will follow those protections when they apply.

Utah

Utah law may provide additional rights concerning access to and the format of health records, including electronic copies when legally required, and may provide additional protection for particular sensitive information. We will follow those requirements when they apply.

North Carolina

North Carolina law may provide additional confidentiality protections for privileged medical information, reportable communicable-disease information, and certain mental health, developmental-disability, and substance use disorder records. We will follow those protections when they apply.

If you have a question about which state law applies to your information, contact our Privacy Officer using the information at the end of this notice.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information, provide you with this notice of our legal duties and privacy practices, and follow the duties and privacy practices described in the notice currently in effect. We will notify affected individuals following a breach of unsecured protected health information as required by law.
• We will not use or disclose your information other than as described in this notice unless you give us written authorization. If you authorize a use or disclosure, you may revoke that authorization in writing at any time, except to the extent we have already relied on it.

Changes to This Notice

We may change this notice and make the revised notice effective for all health information we maintain, including information created or received before the change. When we make a material change, we will post the current notice on our website and make copies available at our locations and upon request. The effective date appears on the first page.

Questions or Complaints

If you have questions, want to exercise a privacy right, or believe your privacy rights have been violated, contact:

Joe Martin, Privacy Officer
Sensibly Sprouted LLC
privacy@sensiblysprouted.com
(360) 230-8182
12 Bellwether Way, Suite 223
Bellingham, WA 98225

You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by writing to 200 Independence Avenue SW, Washington, DC 20201; calling 1-877-696-6775; or visiting the HHS complaint website: www.hhs.gov/hipaa/filing-a-complaint/

We will not retaliate against you for filing a complaint.

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