Nova Health LLC, PLLC

1600 S 70th St, Ste 200, Lincoln NE 68506

Phone: 531-233-5550 Fax: 531-233-5550

Email: info@novahealthne.com - Website: novahealthne.com

HIPAA Notice Of Privacy

NOTE: 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.

OUR OBLIGATIONS:

We are required by law to:

• Maintain the privacy of protected health information

• Give you this notice of our legal duties and privacy practices regarding health information about you

• Follow the terms of our notice that is currently in effect

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION:

The following describes the ways we may use and disclose health information that identifies you (“Health Information”). Except for the purposes described below, we will use and disclose Health Information only with your written permission. You may revoke such permission at any time by writing to our practice admin staff.

For Treatment. We may use and disclose Health Information for your treatment and to provide you with treatment-related health care services. For example, we may disclose Health Information to doctors, nurses, technicians, or other personnel, including people outside our office, who are involved in your medical care and need the information to provide you with medical care.

For Payment. We may use and disclose Health Information so that we or others may bill and receive payment from you, an insurance company, or a third party for the treatment and services you received. For example, we may give your health plan information about you so that they will pay for your treatment.

For Health Care Operations. The Agency will use your health information for healthcare operations. For example, Agency therapists, nurse practitioners, workers, supervisors, and support staff may use information in your case record to assess the care and outcomes of your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the services we provide. Regulatory and accrediting organizations may review your case record to ensure compliance with their requirements.

Appointment Reminders, Treatment Alternatives, and Health-Related Benefits and Services.

We may use and disclose Health Information to contact you to remind you that you have an appointment with us. We also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

Individuals Involved in Your Care or Payment for Your Care. When appropriate, we may share Health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.

SPECIAL SITUATIONS:

As Required by Law. We will disclose Health Information when required to do so by international, federal, state or local law.

To Avert a Serious Threat to Health or Safety. We may use and disclose Health Information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Disclosures, however, will be made only to someone who may be able to help prevent the threat.

Business Associates. We may disclose Health Information to our business associates who perform functions on our behalf or provide us with services if the information is necessary for such functions or services. For example, we may use another company to perform billing services on our behalf. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.

Consent for Remote Scribe Services: We may disclose Health Information to our business associates who perform functions on our behalf or provide services to us, provided that such disclosure is necessary for those functions or services. For instance, we may engage another company to conduct scribe services on our behalf. All of our business associates are bound by contractual obligations to safeguard the privacy of your information. They are prohibited from using or disclosing any information beyond the scope specified in our contract.

Organ and Tissue Donation. If you are an organ donor, we may use or release Health Information to organizations that handle organ procurement or other entities engaged in the procurement, banking, or transportation of organs, eyes, or tissues to facilitate organ, eye, or tissue donation and transplantation.

Military and Veterans. If you are a member of the armed forces, we may release Health Information as required by military command authorities. We also may release Health Information to the appropriate foreign military authority if you are a member of a foreign military.

Workers’ Compensation. We may release Health Information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

Public Health Risks. We may disclose Health Information for public health activities. These activities generally include disclosures to prevent or control disease, injury, or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify people of recalls of products they may be using; a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities. We may disclose Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Data Breach Notification Purposes. We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your health information.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose Health Information in response to a court or administrative order. We also may disclose Health Information in response to a subpoena, discovery request, or other lawful processes by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement. We may release Health Information if asked by a law enforcement official if the information is: (1) in response to a court order, subpoena, warrant, summons, or similar process; (2) limited information to identify or locate a suspect, fugitive, material witness, or missing person; (3) about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement; (4) about a death we believe may be the result of criminal conduct; (5) about criminal conduct on our premises; and (6) in an emergency to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners, and Funeral Directors. We may release Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased

person or determine the cause of death. We also may release Health Information to funeral directors as necessary for their duties.

National Security and Intelligence Activities. We may release Health Information to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.

Protective Services for the President and Others. We may disclose Health Information to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or to conduct special investigations.

Inmates or Individuals in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release Health Information to the correctional institution or law enforcement official. This release would be if necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT

If we need to use or disclose your health information for purposes other than treatment, payment, or health care operations, as required by law, or for a reason not described in this Notice, we will need to obtain authorization from you. Specific examples where we would need your authorization include if your health information includes psychotherapy notes or if we would receive payment for the information because of its sale or because of a third party’s marketing purposes. However, Nova Health LLC does not sell health information or provide it to third parties in exchange for payment to us where the information may be used for the third party’s own marketing. Nova Health LLC also does not create or maintain separate psychotherapy notes.

Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care, If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.

Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we practically can do so.

Fundraising Provisions: We may contact you to raise funds for our programs and operations. You have the right to opt-out of future fundraising communications. Our fundraising communications with you will inform you how you may opt out of future fundraising communications.

Marketing: If we are paid by a third party to allow it to market its own services or goods to our patients, an authorization from each individual whose PHI is to be disclosed to the third party will be obtained. The authorization for marketing purposes must state that remuneration has been or will be received by us in exchange for the disclosure of PHI.

Authorization revocations: You may revoke an authorization you provide to us at any time in writing by contacting our CEO using the contact information in this Notice. Revocation of authorization will be effective except to the extent we have already taken action in reliance upon your authorization. Revocation of an authorization will not apply if the authorization was obtained as a condition of your obtaining insurance coverage and other law provides the insurer with the right to contest a claim under the policy or contest the policy itself.

YOUR RIGHTS:

You have the following rights regarding Health Information we have about you:

Right to Inspect and Copy. You have a right to inspect and copy Health Information 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. To inspect and copy this Health Information, you must make your request, in writing, to our admin staff. We have up to 30 days to make your Protected Health Information available to you and we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We may not charge you a fee if you need the information for a claim for benefits under the Social Security Act or any other state of federal needs-based benefit program. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed healthcare professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review.

Right to an Electronic Copy of Electronic Medical Records. If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. We will make every effort to provide

access to your Protected Health Information in the form or format you request if it is readily producible in such form or format. If the Protected Health Information is not readily producible in the form or format you request your record will be provided in either our standard electronic format or if you do not want this form or format, a readable hard copy form. We may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.

Right to Receive Notification of Certain Breaches. You have the right to receive a notification from us if your health information is accessed, disclosed, or used in violation of federal privacy laws. We will provide you written notice if (1) your personal health information is not secured according to federal standards, (2) the information is accessed, disclosed, or used in violation of federal laws, and (3) the access, disclosure, or use would compromise the security or privacy of the information. This notification will contain important information about the breach and where you can obtain further information.

Right to Amend. If you feel that Health Information we have 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 our office. To request an amendment, you must make your request, in writing, to CEO.

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Health Information for purposes other than treatment, payment and health care operations or for which you provided written authorization. To request an accounting of disclosures, you must make your request, in writing, to CEO.

Right to Request Restrictions. You have the right to request a restriction or limitation on the Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. For most requests, we are not required to agree to your requested restrictions. We are required, however, to agree to a restriction you request if the request pertains to a disclosure to a health plan for payment or health care operations, the disclosure is not otherwise required by law and the PHI only concerns a health care item or service for which you or someone (but not the health plan) on your behalf has paid us in full. To request a restriction, you must make your request, in writing, to CEO.

Right to Inspect and Copy. You have the right to inspect or obtain a copy (or both) of your health information in our records used to make decisions about you for as long as the

information is maintained in the record. You may receive a copy in the form and format you request if the information is readily producible in that form and format. If the PHI is not readily producible as requested, we may provide a readable hard copy form or another form and format as you and we agree. Reasonable cost-based charges may apply. You may designate a person to whom you want your information sent. We will honor your request to send your information to another person or entity if you have clearly and specifically provided us that person’s contact information in writing. In some limited cases, we may deny your request to access your information. In some cases, you may have this decision reviewed. On your request, we will discuss with you the details of the request and denial review process.

Out-of-Pocket-Payments. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.

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 by mail or at work. To request confidential communications, you must make your request, in writing, to CEO. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.

Right to Accounting Provision: In some circumstances, if we maintain an electronic health record about you, you may have the right to receive an accounting of disclosures, for the last three years, which were made for treatment, payment or healthcare operations purposes.

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 of this notice. To obtain a paper copy of this notice, please ask our front desk receptionist.

CHANGES TO THIS NOTICE:

We reserve the right to change this notice and make the new notice apply to Health Information we already have as well as any information we receive in the future. We will post a copy of our current notice at our office. 

COMPLAINTS:

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact CEO. All complaints must be made in writing. You will not be penalized for filing a complaint.

For more information, please contact:

Attn: CEO

Nova Health LLC

1600 S 70th Street, Ste 200

Lincoln NE, 68506

Phone: 531-233-5550

For more information about HIPAA or to file a complaint:

HIPAA Privacy and Security Office, DHHS

301 Centennial Mall South 3rd Floor

Lincoln, NE 68509-5026

by phone at 402-471-4068,

or by email to DHHS.HIPAAOffice@nebraska.gov