HIPAA: Notice of Privacy Practices

SECOND TO NATURE

208 W DAWES AVE

LINCOLN NE 68521

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.

DATE OF NOTICE 2-4-03                                  PRIVACY POLICY

SECTION A: Uses and Disclosures of Protected Health Information

1.        Under applicable law, we are required to protect the privacy of your individual health information (information we refer to in this notice as “protected Health Information”).  We are also required to provide you with this notice regarding our policies and procedures regarding your Protected Health Information and to abide by the terms of this notice, as it may be updated from time to time.

We are permitted to make certain types of uses and disclosures under applicable law for treatment, payment, and healthcare operations purposes.  For treatment purposes, such use and disclosure will take place in providing, coordination, or managing healthcare and its related services by one or more of your providers, such as when your healthcare professional consults with your physician or a specialist regarding your treatment or condition.

For payment purposes, such use and disclosure will take place to obtain or provide reimbursement for providing healthcare services such as when your case is reviewed to ensure that appropriate care was rendered.  For reimbursement purposes, your Protected Health Information may be disclosed to one or several intermediaries employed by your plan sponsor including but not limited to insurers, benefits managers, claims administrators and computer switching companies.

For healthcare operations purposes, such use and disclosure will take place in a number of ways, including for quality assessment and improvement, provider review and training, underwriting activities, reviews and compliance activities; planning, development, management and administration.  Your information could be used, for example, to assist in the evaluation of the quality of care that you were provided.

In addition, we may contact you to provide healthcare reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.  In addition, we may disclose your health information to your plan sponsor.

We may use and disclose your Protected Health Information, without your authorization when the healthcare department needs to contact a physician or physician’s staff and is permitted or required to do so without  individual written consent or authorization.  We may use and disclose your Protected Health Information if we are contacted by another healthcare agency who state they have your request and consent to transfer records to them.

Other uses and disclosures will be made only with your written authorization, and you may revoke your authorization by notifying us as described in Section B.

2.        You may ask us to restrict uses and disclosures of your Protected Health Information to carry out treatment, payment, or healthcare operations, or to restrict uses and disclosures to family members, relatives, friends or other persons identified by you who are involved in your care or payment for your care.  However, we are not required to agree to your request.

3.        You have the right to request the following with respect to your Protected Health Information: (I) inspection and copying; (II) amendment or correction; (III) an accounting of the disclosures of this information by us; and (IV ) the right to receive a paper copy of this notice upon request.

In addition, you may request, and we must accommodate the request, if reasonable, to receive communications of Protected Health Information by alternative means or alternative locations.  To make this request please contact , in writing:

                   SECOND TO NATURE

                      208 W DAWES AVE

                      LINCOLN NE 68521

4.        Unless you object we may use your name to reference your healthcare services.  Unless you object , you may be required to sign a signature log form to acknowledge receipt of service and to consent to disclosure of Protected Health Information as outlined herein.  If you object you will be required to sign a private affidavit acknowledging services.  Your failure to comply could result in healthcare professional refusal to provide services.  This information may be disclosed by us to other persons who ask for you or your prescription by name.  You may restrict or prohibit these uses and disclosures by notifying a healthcare representative orally or in writing of your restrictions or prohibition.  In the event of an emergency or your incapacity, we will do what is consistent with known preference, and what we determine to be in your best interest.  We will inform you of any such uses or disclosures under such circumstances and give you an opportunity to object as soon as practicable.

5.        Unless you object we may disclose to one of your family members, to a close personal friend, or to any other person identified by you, Protected Health Information that is directly relevant to the person’s involvement with your care or payment related to your care.  In addition, unless you object we may use or disclose the Protected Health Information to notify, identify or locate a member of your family, your personal representative, another person responsible for care, or certain disaster relief agencies of your location, general condition, or death.  If you are incapacitated, there is an emergency, or you object to this use or disclosure, we will do what in our judgment is in your best interest regarding such disclosure and will disclose only the information that is directly relevant to the person’s involvement with your healthcare.  We will also use our judgment and experience regarding your best interest in allowing people to pick-up filled prescriptions, or other similar forms of Protected Health Information.

6.        We reserve the right to change the terms of this notice and to make new notice provisions effective for all Protected Health Information we maintain.  You may receive a copy of this notice by contacting us as outlined in Section B or upon the receipt of healthcare services.

7.        If you believe that your privacy rights have been violated, you may complain to us at the location described in Section B or to the Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington, DC 20201.  You will not be retaliated against for filing a complaint.

SECTION B: CONTACTING US

You may contact us for further information at:

SECOND TO NATURE           Toll free: 1-800-909-8363

208 W DAWES AVE                 Local  calls: 402-474-3955

LINCOLN NE 68521                FAX: 402-474-3955