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.
If you have any questions about this notice, please contact
Harmony Wellness and Body at (614) 318-4001.
This Notice of Privacy Practices describes how we may use and disclose your protected health
information to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. We will provide you with any revised Notice of Privacy Practices upon your request. You may request a revised version by accessing our website, calling the office to request a revised copy be sent to you in the mail, or asking for one at the time of your next appointment.
i. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your protected health information may be used and disclosed by your physician, our office staff and others outside of our office who are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of your physician’s practice.
Following are examples of the types of uses and disclosures of your protected health information that your physician’s office is permitted to make. These examples are not meant to be exhaustive, but to
describe the types of uses and disclosures that may be made by our office.
Treatment: We will use and disclose your protected health information to provide, coordinate, or
manage your health care and any related services. This includes the coordination or management of
your health care with another provider. For example, we would disclose your protected health
information, as necessary, to a home health agency that provides care to you. We will also disclose
protected health information to other physicians who may be treating you. For example, your
protected health information may be provided to a physician to whom you have been referred to
ensure that the physician has the necessary information to diagnose or treat you. In addition, we may
disclose your protected health information from time to time to another physician or health care
provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in
your care by providing assistance with your health care diagnosis or treatment to your physician.
Payment: Your protected health information will be used and disclosed as needed to obtain payment
for your health care services provided by us or another provider.
Health Care Operations: We may use or disclose, as needed, your protected health information to
support the business activities of your physician’s practice. These activities include, but are not
limited to, quality assessment activities, employee review activities, training of medical students,
licensing, fundraising activities, and conducting or arranging for other business activities.
We will share your protected health information with third-party “business associates” who perform
various activities (for example, billing or transcription services) for our practice. Whenever an
arrangement between our office and a business associate involves the use or disclosure of your
protected health information, we will have a written contract that contains terms that will protect the
privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with
information about treatment alternatives or other health-related benefits and services that may be of
interest to you. You may contact our office to request that these materials not be sent to you.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization
or Opportunity to Agree or Object
We may use or disclose your protected health information in the following situations without your
authorization or providing you the opportunity to agree or object. These situations include:
Required By Law: We may use or disclose your protected health information to the extent that the use
or disclosure is required by law. The use or disclosure will be made in compliance with the law and will
be limited to the relevant requirements of the law. You will be notified of any such uses or disclosures
if required by law.
Public Health: We may disclose your protected health information for public health activities and
purposes to a public health authority that is permitted by law to collect or receive the information.
For example, a disclosure may be made to prevent or control disease, injury, or disability.
Communicable Diseases: We may disclose your protected health information, if authorized by law, to
a person who may have been exposed to a communicable disease or may otherwise be at risk of
contracting or spreading the disease or condition.
Health Oversight: We may disclose protected health information to a health oversight agency for
activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking
this information include government agencies that oversee the health care system, government benefit
programs, other government regulatory programs, and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a public health authority that
is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your
protected health information if we believe that you have been a victim of abuse, neglect, or domestic
violence to the governmental entity or agency authorized to receive such information. In this case, the
disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health information to a person or
company required by the Food and Drug Administration for the purpose of quality, safety, or
effectiveness of FDA-regulated products or activities including, to report adverse events, product
defects, or problems, biologic product deviations, to track products; to enable product recalls; to
make repairs or replacements, or to conduct post-marketing surveillance, as required.
Legal Proceedings: We may disclose protected health information in the course of any judicial or
administrative proceeding, in response to an order of a court or administrative tribunal (to the extent
such disclosure is expressly authorized), or in certain conditions in response to a subpoena, discovery
request or other lawful process.
Law Enforcement: We may also disclose protected health information, so long as applicable legal
requirements are met, for law enforcement purposes. These law enforcement purposes include (1)
legal processes and otherwise required by law, (2) limited information requests for identification and
location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result
of criminal conduct, (5) in the event that a crime occurs on the premises of our practice, and (6)
in a medical emergency (not on our practice’s premises) and it is likely that a crime has
occurred.
Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a
coroner or medical examiner for identification purposes, determining the cause of death, or for the
coroner or medical examiner to perform other duties authorized by law. We may also disclose protected
health information to a funeral director, as authorized by law, in order to permit the funeral director to
carry out their duties. We may disclose such information in reasonable anticipation of death. Protected
health information may be used and disclosed for cadaveric organ, eye, or tissue donation purposes.
Research: We may disclose your protected health information to researchers when their research has
been approved by an institutional review board that has reviewed the research proposal and
established protocols to ensure the privacy of your protected health information.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected
health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious
and imminent threat to the health or safety of a person or the public. We may also disclose protected
health information if it is necessary for law enforcement authorities to identify or apprehend an
individual.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose
protected health information of individuals who are Armed Forces personnel (1) for activities deemed
necessary by appropriate military command authorities; (2) for the purpose of a determination by the
Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you
are a member of that foreign military services. We may also disclose your protected health information
to authorized federal officials for conducting national security and intelligence activities, including for
the provision of protective services to the President or others legally authorized.
Workers’ Compensation: We may disclose your protected health information as authorized to comply
with workers’ compensation laws and other similar legally established programs.
Inmates: We may disclose your protected health information if you are an inmate of a correctional
facility and your physician created or received it in the course of providing care to you.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written
authorization unless otherwise permitted or required by law as described below. You may revoke this
authorization in writing at any time. If you revoke your authorization, we will no longer use or disclose
your protected health information for the reasons covered by your written authorization. Please
understand that we are unable to take back any disclosures already made with your authorization.
Other Permitted and Required Uses and Disclosures That Require Providing You the Opportunity to
Agree or Object
We may use and disclose your protected health information in the following instances. You have the
opportunity to agree or object to the use or disclosure of all or part of your protected health
information. If you are not present or able to agree or object to the use or disclosure of the protected
health information, then your physician may, using professional judgment, determine whether the
disclosure is in your best interest.
Others 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. We may use or disclose
protected health information to notify or assist in notifying a family member, personal representative,
or any other person who is responsible for your care of your location, or general condition, or any
other person that is responsible for your care of your location, general condition or death. Finally, we
may use or disclose your protected health information to an authorized public or private entity to
assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals
involved in your health care.
ii. YOUR RIGHTS
The following is a statement of your rights regarding your protected health information and a brief
description of how you may exercise these rights.
You have the right to inspect and copy your protected health information. This means you may
inspect and obtain a copy of protected health information about you for so long as we maintain the
protected health information. You may obtain your medical record containing medical and billing
records and any other records that your physician and the practice used to make decisions about you.
As permitted by federal or state law, we may charge you a reasonable copy fee for a copy of your
records.
Under federal law, however, you may not inspect or copy the following records: psychotherapy notes;
information compiled in reasonable anticipation of, or use in a civil, criminal, or administrative action
or proceeding; and laboratory results that are subject to law that prohibits access to protected health
information. Depending on the circumstances, a decision to deny access may be reviewable. In some
circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer
if you have questions about access to your medical record.
You have the right to request a restriction of your protected health information. This means you
may ask us not to use or disclose any part of your protected health information for the purposes of
treatment, payment, or healthcare operations. You may also request that any part of your protected
health information not be disclosed to family members or friends who may be involved in your care or
for notification purposes as described in this Notice of Privacy Practices. Your request must state the
specific restriction requested and to whom you want the restriction to apply.
Your physician is not required to agree to a restriction that you may request. If your physician does
agree to the requested restriction, we may not use or disclose your protected health information in
violation of that restriction unless it is needed to provide emergency treatment. You may request a
restriction by writing to Harmony Wellness and Body, 720 Worthington Woods Blvd, Columbus, Ohio
43085.
You have the right to request to receive confidential communications from us by alternative means
or at an alternative location. We will accommodate reasonable requests. We may also condition this
accommodation by asking you for information on how payment will be handled or the specification of
an alternative address or other contact method. We will not request an explanation from you as to the
basis for the request. Please make a written request to Harmony Wellness and Body, 720 Worthington
Woods Blvd, Columbus, Ohio 43085.
You may have the right to have your physician amend your protected health information. This
means you may request an amendment of protected health information about you in a designated
record set for so long as we maintain this information. In certain cases, we may deny your request for
an amendment. If we deny your request for amendment, you have the right to file a statement of
disagreement with us, and we may prepare a rebuttal to your statement and provide you with a
copy of any such rebuttal. Please contact Harmony Wellness and Body if you have questions about
amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your
protected health information. This right applies to disclosures for purposes other than treatment,
payment, or health care operations as described in this Notice of Privacy Practices. It excludes
disclosures we may have made to you if you authorized us to make the disclosure for a facility
directory, to family members or friends involved in your care, or for notification purposes, for national
security or intelligence, to law enforcement (as provided in the privacy rule) or correctional facilities,
as part of a limited data set disclosure. You have the right to receive specific information regarding
these disclosures that occur after April 14, 2003. The right to receive this information is subject to
certain exceptions, restrictions, and limitations.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have
agreed to accept this notice electronically.
iii. COMPLAINTS
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy
rights have been violated by us. You may file a complaint with us by notifying Harmony Wellness and
Body of your complaint. We will not retaliate against you for filing a complaint.
You may contact us for further information about the complaint process.
This notice was published and becomes effective on June 5, 2024.
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