This Notice of Privacy Practices (this “Notice”) describes how medical information about you may be used and disclosed by Thrive Place, LP (“we” or “Thrive”), and your rights regarding this information. Please review this Notice carefully.
If you have any questions about this Notice, please contact Thrive at email@example.com.
Any information that you submit to us about your child that constitutes “Protected Health Information,” (PHI) as defined by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and its implementing regulations, is subject to HIPAA and applicable state law. HIPPA requires that we provide you with a notice regarding how the PHI may be used or disclosed and your rights concerning that information.
HIPPA provides you with certain rights regarding your child’s information, including:
- Receiving an electronic or paper copy of your child’s medical record;
- Asking us to correct your child’s medical information;
- Requesting confidential communication;
- Asking us to limit what we use or share;
- Requesting a list of the times we have shared your child’s information and with whom for the 6 years prior to the date you asked;
- Requesting a copy of this Notice;
- Appointing someone as your child’s medical power of attorney to exercise your child’s rights under HIPPA; and
- Notification following a breach of your child’s PHI.
To exercise any of your rights under this notice, please submit a request in writing to firstname.lastname@example.org.
For certain health information, you can tell us your choices about what we share, including:
- Sharing information with your family, close friends, or others involved in your care;
- Sharing your information in a disaster relief and situation; and
- Including your information in a directory.
We will never share your child’s information unless you give us written permission in these cases:
- Marketing purposes;
- Sale of your information; and
- Most sharing of psychotherapy notes.
We may contact you for fundraising efforts, but you can tell us not to contact you again.
Use and Disclosure
Thrive will not use or disclose your PHI, except as permitted by law.
We may use and disclose your child’s medical information in the following ways:
- To provide your child with medical treatment or services, including disclosing medical information about your child to doctors, nurses, technicians, or other personnel who are involved in your child’s care;
- To obtain payment for our services, as needed; and
- To support business activities at Thrive, including quality assessment activities, employee review, training, contacting you, and conducting or arranging for other business activities.
As required by law, we may also use and disclose your child’s medical information for the following types of entities, including but not limited to:
- Food and Drug Administration
- Public Health or legal authorities charged with preventing or controlling disease, injury, or disability
- Correctional Institutions
- Workers Compensation agents
- Organ and tissue donation organizations
- Military command authorities
- Health oversight agencies
- Funeral directors, coroners and medical directors
- National Security and Intelligence Agencies
- Protective Services for the President and Others
- Law enforcement authorities
We may also share your child’s medical information in response to a court or administrative order, or in response to a subpoena.
We are required by law to maintain the privacy and security of your child’s PHI. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your child’s PHI.
We must follow the duties and privacy practices described in this Notice and provide a copy of it to you. We will not use or share your child’s 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. Let us know in writing if you change your mind.
Some of the services provided by Thrive are provide through contracts with business associates. When these services are contracted, we may disclose your child’s health information to our business associates so that they can perform the job we’ve asked them to do. To protect your PHI, however, we require the business associates to appropriately safeguard your child’s information. Thrive’s requirements for safeguarding your information are included in Business Associate Agreements with each such entity. In addition, all business associates are subject to oversight by the Secretary of the Health and Human Services and must adhere to all requirements of HIPAA.
If you feel Thrive has violated your child’s rights, you may contact us at email@example.com. You may 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, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
You will not be penalized for filing a complaint about Thrive’s Privacy Practices.
Changes to this Notice
We may change the terms of our notice, at any time. The new notice will be effective for all PHI that we maintain at that time. Upon your request, we will you provide you with any revised Notice of Privacy Practices. You many request a revised copy at firstname.lastname@example.org or visiting our website at myelinet.com.