Notice of Privacy Practices

Your rights

When it comes to your health information, you have certain rights.

Get an electronic or paper copy of your record

You can ask to see or get an electronic or paper copy of your health record and other health information we have about you. We will provide a copy or a summary, usually within 30 days of your request, and we may charge a reasonable, cost based fee.

Ask us to correct your record

You can ask us to correct health information about you that you think is incorrect or incomplete. We may say no to your request, but we will tell you why in writing, generally within 60 days.

Request confidential communications

You can ask us to contact you in a specific way, for example by a particular phone number or email address. We will say yes to all reasonable requests.

Ask us to limit what we use or share

You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree, and we may say no if it would affect your care. If you pay for a service in full out of pocket, you can ask us not to share that information with your health insurer, and we will say yes unless a law requires us to share it.

Get a list of those with whom we have shared information

You can ask for a list, called an accounting, of the times we have shared your health information for six years prior to the date you ask, who we shared it with, and why. We will include all disclosures except those about treatment, payment, and healthcare operations, and certain other disclosures such as those you asked us to make. One accounting per year is free, and we may charge a reasonable, cost based fee for additional requests.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive it electronically, and we will provide one promptly.

Choose someone to act for you

If you have given someone medical power of attorney, or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will verify that the person has this authority before we take any action.

File a complaint if you feel your rights are violated

You can complain to us by contacting info@sleep-change.com. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue SW, Washington, D.C. 20201, by calling 1-877-696-6775, or by visiting hhs.gov/hipaa/filing-a-complaint. We will not retaliate against you for filing a complaint.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us and tell us what you want us to do.

You have both the right and the choice to tell us to:

• share information with your family, close friends, or others involved in your care;
• share information in a disaster relief situation.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest, or when needed to lessen a serious and imminent threat to health or safety.

We never share your information for marketing purposes, and we never sell your information. Most sharing of psychotherapy notes requires your written authorization. Other uses and disclosures not described in this notice will be made only with your written authorization, which you may revoke at any time in writing, except to the extent we have already acted on it.

Our uses and disclosures

We typically use or share your health information in the following ways.

To treat you

We can use your health information and share it with other professionals who are treating you, for example your physician, sleep physician, or another clinician involved in your care, when appropriate and permitted.

To run our practice

We can use and share your information to run our practice, improve your care, and contact you when necessary, including scheduling and administrative communication.

To bill for your services

We can use and share your health information to bill and receive payment. Our practice is private pay and does not bill insurers directly. If you request a superbill or other documentation so that you can seek out of network reimbursement, that document will contain health information that you then submit to your plan.

Other ways we may use or share your information

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. These include:

• helping with public health and safety issues, including preventing disease and reducing a serious and imminent threat to health or safety;
• research, subject to applicable legal conditions;
• complying with federal, state, or local law;
• responding to organ and tissue donation requests, and working with a medical examiner or funeral director;
• addressing workers compensation, law enforcement, and other government requests, including for military, national security, and protective services;
• responding to lawsuits and legal actions, such as a court or administrative order or a lawful subpoena;
• reporting suspected abuse, neglect, or domestic violence as required by law.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing.

For more information, see hhs.gov/hipaa/for-individuals/notice-privacy-practices.

Telehealth and electronic communication

Clinical services are provided in person and by telehealth. Telehealth sessions use platforms intended for healthcare use, and electronic communication carries inherent risks that are reviewed with you during the informed consent process. Email and website forms are not secure channels for clinical information and are not used as a substitute for the clinical record.

Changes to the terms of this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on this website.

Contact

Privacy questions, requests, and complaints may be directed to Sleep & Change Specialists, LLC at info@sleep-change.com. This notice is provided in accordance with federal privacy regulations and applicable state law, and follows the plain language model notice for health care providers published by the U.S. Department of Health and Human Services Office for Civil Rights.