HIPAA NOTICE OF PRIVACY PRACTICES

This Notice Describes How Medical Information About You May Be Used And Disclosed And How You May Receive Access To This Information.

Please Review It Carefully.

​

1. Our Commitment To You

Rootleaf is committed to maintaining the privacy of your health information. This Notice explains how that information, called “Protected Health Information” may be used and disclosed to others. The terms of this Notice apply to health information produced or obtained by Rootleaf.

2. Our Legal Duties

The HIPAA Privacy Law requires us to provide this Notice to all participants regarding our privacy practices, our legal duties to protect your private information and your rights concerning health information about you. We are required to follow the privacy practices described in this Notice whenever we use or disclose your protected health information (PHI). Other companies or persons that perform services on our behalf, called Business Associates, must also protect the privacy of your information. Business Associates are not allowed to release your information to anyone else unless specifically permitted by law. There may be other state and federal laws, which provide additional protections related to communicable disease, mental health, substance or alcohol abuse, or other health conditions.

3. Your Health Information May Be Used And Disclosed 

The HIPAA Privacy Law permits Rootleaf to make uses and disclosures of your health information for purposes of treatment, payment and health care operations.

• Treatment: We will use and may share health information about you for your health care and treatments. For example, a clinician will obtain treatment information about you and record it in a medical record. Alternatively, one of our physicians may use information about you for a consultation with, or a referral to, another physician to diagnose your illness and determine which treatment option will best address your health needs. Except in emergency circumstances, we will make a “good faith effort” to get your permission prior to making disclosures outside Rootleaf for treatment purposes. 

• Payment: We may use and disclose health information about you to obtain payment for the care and services that we have provided to you. For example, we may need to provide your health plan provider with information about you, your diagnosis, and the treatment provided to you so that your health insurer will pay for the treatment. We may also contact your health insurance to obtain prior approval about a potential treatment. 

• Health Care Operations: We may use and share health information about you for Rootleaf’s health care operations, which include planning, management, quality assessment, and improvement activities for the treatments that we deliver. For example, we may use your health information to evaluate the skills of our clinicians and other healthcare providers in caring for you. We also may use your information to review quality and health outcomes. We will obtain your written permission before making disclosures to others outside Rootleaf for health care operations purposes.

• Appointment Reminders: We may use and disclose PHI to contact you for appointment reminders and to communicate necessary information about your appointment.

• Health-Related Benefits, Services and Treatment Alternatives: We may also contact you about new or alternative treatments or other health care services.

• Fundraising Communications: We may contact you as part of a fundraising effort. For example, we may use your information to contact you in an effort to raise money for Rootleaf and its operations. We would only release your name, address and phone number, and the dates you received services at Rootleaf. If you do not want us to contact you for fundraising efforts, you must notify Rootleaf in writing.

• People Assisting in Your Care: In certain limited situations, Rootleaf may disclose essential health information to people such as family members, relatives, or close friends who are helping care for you or helping you pay your health care bills. We will disclose information to them only if these people need to know the information to help you. For example, we may provide limited information to a family member so that they may pick up a prescription for you. Generally, we will ask you prior to making disclosures if you agree to such disclosures. If you are unable to make health-related decisions or it is an emergency, Rootleaf will determine if it would be in your best interest to disclose pertinent health information about you to the people assisting in your care.

• Research: Federal law permits Rootleaf to use or disclose health information about you for research purposes, if the research is reviewed and approved by an Institutional Review Board to protect the privacy of your health information before the study begins. We may disclose your information if we have your written authorization to do so. In some instances, researchers may be allowed to use information about you in a restricted way to determine whether the potential study participants are appropriate. We will make a “good faith effort” to acquire your permission or rejection to participate in any research study prior to releasing any protected information about you.

• As Required by Law: We must disclose health information about you if federal, state, or local law requires us. 

• Serious Threat to Health or Safety: Consistent with applicable laws, we may disclose your PHI if disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We also may disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

• Public Health Risks: As authorized by law, we may disclose health information about you to public health or legal authorities whose official responsibilities generally include the following:

  • To prevent or control disease, injury or disability;

  • To report births and deaths;

  • To report child abuse or neglect;

  • To report reactions to medications or problems with products;

  • To notify people of recalls of products they may be using;

  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and

  • To notify 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.

• Organ and Tissue Donation: Consistent with applicable law, we may release your health information to organ procurement organizations or others engaged in the transplantation of organs to enable a possible transplant.

• Specialized Government Functions: If you are a member of the military or a veteran, we will disclose health information about you as required by command authorities; or if you give us your written permission. We may also disclose your health information for other specialized government functions such as national security or intelligence activities.

• Workers Compensation: If you are seeking compensation due to a work-related injury, we may release health information about you to the extent necessary to comply with laws relating to Workers Compensation claims.

• Employers: We may release health information to your employer if we provide health treatment to you at the request of your employer, and the health care services are provided either to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related illness or injury. In such circumstances, we will provide you with written notice of such information disclosure. Any other disclosures to your employer will be made only if you sign a specific authorization for the release of that information.

• Health Oversight Activities: We must disclose health information to a health oversight agency for activities that are required by federal, state or local law. Oversight activities include investigations, inspections, industry licensures, and government audits. These activities are necessary to enable government agencies to monitor various health care systems, government programs, and industry compliance with civil rights laws. Most states require that identifying information about you, such as your social security number, be removed from information releases for health oversight purposes, unless you have provided written permission for the disclosure.

• Lawsuits and Disputes: If you are involved in a lawsuit, dispute, or other judicial proceeding, we may disclose health information about you in response to a court order or subpoena, other lawful process, 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 disclose your health information to a law enforcement official if required or allowed by law, such as for gunshot wounds and some burns. We may also disclose information about you to law enforcement that is not a part of your health record for the following reasons:

  • To identify or locate a suspect, fugitive, material witness, victim of a crime, or missing person

  • About a death we believe may be the result of criminal conduct

  • About criminal conduct at our location 

  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

• Correctional Facilities: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose health information about you to the correctional institution or law enforcement official only as required by law or with your written permission. We may release your health information for your health and safety, for the health and safety of others, or for the safety and security of the correctional institution.

• Coroners, Medical Examiners, and Funeral Directors: We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may also release your PHI to a funeral director, as necessary, to carry out his/her duties.

• Required by HIPAA Law: The Secretary of the Department of Health and Human Services (HHS) may investigate privacy violations. If your health information is requested as part of an investigation, we must share your information with HHS. 

4. Situations In Which Your Health Information May Be Disclosed With Your Written Consent

For any purpose other than the ones described above, we may only use or share your health information when you give us your written authorization to do so. For example, you will need to sign an authorization form before we can send your health information to your life insurance company. You may revoke an authorization at any time.

• Marketing: We must also obtain your written authorization before using your health information to send you any marketing materials. The only exceptions to this requirement are that:

  • We can provide you with marketing materials in a face-to-face encounter or a promotional gift of very small value, if we so choose

  • We may communicate with you about products or services relating to your treatment, to coordinate or manage your care, or provide you with information about different treatments, providers or care settings. 

• Highly Confidential Information: Federal and state law requires special privacy protections for certain information about you. Before we share your Highly Confidential Information for a purpose other than those permitted by law, we must obtain your written permission. Such information includes: 

  • Child abuse and neglect

  • Domestic abuse of an adult with a disability 

  • Mental illness or developmental disability treatment or services

  • Alcohol or drug dependency diagnosis, treatment, or referral

  • HIV/AIDS testing, diagnosis, or treatment

  • Sexually transmitted disease

  • Sexual assault

  • Genetic testing

  • In Vitro Fertilization (IVF)

  • Information maintained in psychotherapy notes

​

5. Your Rights Regarding Health Information We Maintain About You

• Right to Inspect and Copy: You have the right to receive a copy of your PHI. For copies of your PHI, requests must go to the Privacy Officer. For PHI in a designated record set that is maintained in an electronic format, you can request an electronic copy of such information. There may be a charge for copies of your PHI.

• Right to Request Amendment: If you believe that any health information we have about you is incorrect or incomplete, you have the right to ask us to change the information, for as long as Rootleaf maintains the information. To request an amendment to your health information, your request must be in writing, signed, and submitted to Rootleaf. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement that will be maintained with your records. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information. 

• Right to Request Restrictions on Use and Disclosure: You have the right to request a restriction or limitation on certain uses and disclosures of your health information. To request restrictions, you must make your request in writing. In your request, you must tell us:

  • What information you wish to limit 

  • Whether you wish to limit our use, disclosure, or both

  • To whom you want the limits to apply. ​For example, if you want to prohibit disclosures for insurance payment, health care operations, for disaster relief purposes, to persons involved in your care, or to your spouse. You or your personal representative must sign it. We are not required to agree to your request, but we will attempt to accommodate reasonable requests when appropriate. We retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction. 

• Right to an Accounting of Disclosures: With some exceptions, you have the right to receive an accounting of certain disclosures of your PHI. Your accounting request must be in writing and signed by you or your personal representative, and submitted to Rootleaf. Your request must specify the time in which the disclosures were made. These disclosures may not go back further than six years from the date of the request.

• Right to Request Alternate Communications: You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location. For example, you may ask that we only contact you via mail to a post office box. You must submit your request in writing to Rootleaf. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.

• Right to Receive a Copy of this Notice: You have the right to a paper copy of this Notice of Privacy Practices even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of this Notice at any time. 

• Right to Cancel Authorization to Use or Disclose: Other uses and disclosures of your health information not covered by this Notice or the laws that govern us will be made only with your written authorization. You have the right to revoke your authorization in writing at any time, and we will discontinue future uses and disclosures of your health information for the reasons covered by your authorization. We are unable to take back any disclosures that were already made with your authorization, and we are required to retain the records of the care that we provided to you. 

6. Additional Information

• For further information: If you have questions, or would like additional information, you may contact the HIPAA Privacy Officer via the contact information below.

• To File a Complaint: You may submit any complaints with respect to violations of your privacy rights to Rootleaf. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services if you feel that your rights have been violated. There will be no retaliation from Rootleaf for making a complaint.

• Changes to this Notice: If we make a material change to this Notice, we will provide a revised Notice available on our website.

• Contact Information: Unless otherwise specified, to exercise any of the rights described in this Notice, for more information, or to file a complaint, please contact the Privacy Officer by email at privacy@rootleafbilling.com or by mail to:
  
  Attn: Privacy Officer
  Rootleaf, LLC
  4260 Gertrude St.
  Simi Valley, CA 93063
  United States