Notice of Privacy Practices

Effective [EFFECTIVE DATE]  ·  Last updated [DATE]

This Notice applies to protected health information (“PHI”) created or received by [LEGAL ENTITY NAME] and the licensed providers who deliver care through Omni Health System. It does not apply to information you enter purely for wellness tracking that is never used for treatment — that information is covered by our Privacy Policy.

Our duties

We are required by law to maintain the privacy of your PHI, to give you this Notice of our legal duties and privacy practices, to follow the terms of the Notice currently in effect, and to notify you if a breach compromises the privacy or security of your PHI.

How we may use and disclose your PHI without your authorization

Treatment

To provide, coordinate, and manage your care — for example, sharing your record with the physician reviewing your program, or sending a prescription to a dispensing pharmacy.

Payment

To bill and collect for services — for example, determining eligibility, or submitting claims where applicable.

Health care operations

To run our practice — quality assessment, provider review, care coordination, training, and business management.

Business associates

We use vendors who perform services on our behalf and may handle PHI. Each signs a Business Associate Agreement requiring them to protect your PHI.

As required or permitted by law

Including public health activities, reporting abuse or neglect, health oversight activities, judicial and administrative proceedings, law enforcement in specified circumstances, serious threats to health or safety, workers' compensation, and organ donation.

Uses that always require your written authorization

• Marketing that involves payment from a third party.
• Sale of PHI. We do not sell PHI.
• Psychotherapy notes, where they exist.
• Most other uses not described in this Notice.

You may revoke an authorization in writing at any time, except to the extent we have already acted on it.

Your rights

• Inspect and copy your designated record set, including an electronic copy where we hold it electronically. We will respond within 30 days.
• Request an amendment if you believe information is incorrect or incomplete. We may deny the request, and you may file a statement of disagreement.
• Receive an accounting of disclosures made in the six years prior to your request, other than those for treatment, payment, and operations.
• Request restrictions on uses and disclosures. We are not required to agree, except that we must agree to withhold information from a health plan when you pay in full out of pocket for that service.
• Request confidential communications by a particular means or at a particular location.
• Receive a paper copy of this Notice, even if you agreed to receive it electronically.
• Be notified following a breach of unsecured PHI.

Complaints

If you believe your privacy rights have been violated, contact our Privacy Officer below. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services, Office for Civil Rights, at hhs.gov/ocr. We will not retaliate against you for filing a complaint.

Contact

Changes to this Notice

We may change this Notice and make the new terms effective for all PHI we maintain. The current Notice will always be posted here with its effective date.