This Notice describes how medical information about you may be used and disclosed, and how you can get access to this information. It applies to your Protected Health Information (PHI) once a clinical relationship is established. Please review it carefully.
LiteWell is committed to protecting the privacy and confidentiality of your Protected Health Information (PHI).
We are required by law to maintain the privacy of PHI, provide you with this Notice, and follow the terms described herein.
PHI includes information that identifies you and relates to your past, present, or future physical or mental health, healthcare services, or payment for healthcare services.
We may use and disclose your PHI for the following purposes:
Treatment:
We may use and share PHI to provide, coordinate, or manage your care, including with other healthcare providers involved in your treatment.
Payment:
As a direct-pay practice, payment-related use is limited, but may include providing documentation for HSA/FSA or billing purposes.
Healthcare Operations:
We may use PHI to operate our practice, including quality improvement, training, compliance, and administrative functions.
We may disclose PHI without your authorization when required or permitted by law, including:
We will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice, including most marketing uses and disclosures of psychotherapy notes.
You may revoke your authorization at any time in writing, except to the extent action has already been taken.
You have the following rights:
Right to Access:
You may inspect and obtain a copy of your PHI.
Right to Amend:
You may request corrections to your PHI.
Right to an Accounting of Disclosures:
You may request a list of certain disclosures.
Right to Request Restrictions:
You may request limits on how your PHI is used or disclosed.
Right to Confidential Communications:
You may request communications through alternative means or locations.
You have the right to be notified following a breach of unsecured PHI. LiteWell will notify you as required by law if such a breach occurs.
LiteWell is required to:
If you believe your privacy rights have been violated, you may file a complaint with LiteWell or with the U.S. Department of Health and Human Services.
You will not be penalized for filing a complaint.
LiteWell reserves the right to change this Notice at any time. Updated versions will be posted and apply to all PHI we maintain.
If you have questions about this Notice or wish to exercise your rights, you can reach us at:
