Privacy Notice

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.

Healing Medical Group is committed to providing quality healthcare services to you.
An important part of that is protecting your medical information according to applicable law. We understand that your
health information is highly personal, and we are committed to safeguarding your privacy. Please, read this Notice
thoroughly. It describes how we will use and disclose your PHI.

DEFINITIONS
Protected Health Information (PHI) – means information which identifies you (e.g. name, address, social security
number, etc.) and relates to your past, present or future physical or mental health condition; the provision of healthcare
to you; or the past, present or future payment for the provision of healthcare to you.
Healthcare Operations – means business activities that we engage to provide healthcare services to you, including but
not limited to quality assessment and improvement activities, personnel training and evaluation, business planning and
development, and other administrative and managerial functions.
Payment – means activities we undertake as a healthcare provider to obtain reimbursement for the provision of
healthcare to you which include but are not limited to determinations of insurance eligibility or coverage (including
coordination of benefits or the determination of cost sharing amounts), and processing health benefit claims.
Treatment – means the provision, coordination, or management of healthcare and related services on your behalf,
including the coordination or management of healthcare with a third party; consultation between Healing Medical
Group and other healthcare providers relating to your care; or referral by Healing Medical Group of your care to another
healthcare provider.

AUTHORIZATIONS
There are three instances where an Authorization is required from you before we disclose your PHI:
1). Most Uses and Disclosures of psychotherapy notes.
2). Uses and Disclosures for marketing purposes.
3). Uses and Disclosures that involve the sale of PHI.

There are several Disclosures that do not require your Authorization:
1). Public health activities.
2). Research purposes.
3). Your treatment.
4). The sale, transfer, merger or consolidation of all or part of our organization and for related due diligence.
5). Services rendered by a business associate pursuant to a business associate contract and at the specific request of our
organization.
6). Providing you with access to your PHI.
7). Other purposes that the Secretary of the Department of Health and Human Services deems necessary and
appropriate.
You may, at your own discretion, provide us with other Authorizations. It is our Policy only to use and disclose PHI
requiring an Authorization consistent with the Authorization as provided by you. Our Compliance Officer will ensure
that all Authorizations meet the requirements of the Privacy Rule and that our staff is trained regarding those instances
of Uses and Disclosures wherein Authorizations are implicated.

USES AND DISCLOSURES
Uses and Disclosures of your PHI may be permitted, required, or authorized.

TREATMENT, PAYMENT and OPERATIONS
We will use and/or disclose your PHI as follows:
1). To ensure that we appropriately provide for your care and treatment.
2). To obtain payment for our services.
3). As necessary to conduct our Healthcare operations.

TREATMENT
Our staff, including doctors, nurses, and other clinicians, will use your PHI to order tests, procedures, and medications;
and to otherwise provide for your care. We may disclose your PHI to pharmacies and other healthcare providers as
needed.

PAYMENT
Your PHI will be used to check eligibility for insurance coverage and prepare claims for your insurance company where
appropriate. We may also use your PHI to invoice you directly or to invoice a government agency on your behalf.

OPERATIONS
We may use and disclose your PHI to conduct our healthcare business and to perform functions associated with our
business activities.

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APPOINTMENTS AND REMINDERS
We may use your PHI to contact you regarding appointment reminders or information about treatment alternatives or
other health-related benefits and services that may be of interest to you.

OPPORTUNITY TO AGREE OR OBJECT
Under certain circumstances, we may only use and disclose your PHI with your permission as directly provided by you, or
in a context wherein we can reasonably infer it, unless you are not present, are incapacitated, or an emergency exists,
in which case we are compelled by law to use our professional judgment to determine when to use your PHI, and the
extent to which it is used.

FRIENDS AND FAMILY
In your presence, we may only disclose your PHI to friends and family with your expressed permission. In emergency
situations, or if you are not present to agree or object, then we will use our professional judgement regarding any
communications.

NOTIFICATION
We may use or disclose your PHI to notify, or assist in the notification of a family member, a personal representative, or
another person responsible for your care. Any such use or disclosure of your PHI for notification purposes will be made
consistent with this policy and applicable law.

BUSINESS ASSOCIATES
We may use or disclose your PHI to a business associate that performs a business function on our behalf and requires
your PHI to do so. Such use or disclosure will occur after performing due diligence to ensure that the business associate
is meeting all statutory and contractual requirements. A written contract will be executed with each business associate
and will be reviewed on a yearly basis to ensure that the business associate is providing adequate PHI safeguards.

PUBLIC POLICY
There is several uses and disclosures that we are required or permitted to make for public policy reasons. The following
is a list of uses and disclosures pertaining to the relevant requirements of such law.

REQUIRED BY LAW
We may use or disclose your PHI to the extent that such use or disclosure is required by law. In such cases, the
use or disclosure will be limited to uses and disclosures pertaining to the relevant requirements of such law.

PUBLIC HEALTH ACTIVITIES
We may use or disclose your PHI to governmental authorities for public health activities and for purposes
described as follows:
1). Preventing or controlling disease, injury, or disability, including but not limited to: the reporting of disease,
injury, vital events such as birth or death, and the conduct of public health surveillance, public health
investigations, and public health interventions; or, at the direction of a public health authority, to an official of a
foreign government agency that is acting in collaboration with a public health authority.
2). Reporting child abuse or neglect.
3). Activities related to the quality, safety or effectiveness of a Food and Drug Administration regulated product
or process.

4). To persons who may have been exposed to a communicable disease or may otherwise be at risk of
contracting or spreading a disease or condition, if we were authorized by law to notify such persons as necessary
in the conduct of a public health intervention or investigation.
5). To an employer, about an individual who is a member of the workforce of the employer, under a limited set
of conditions.

LAW ENFORCEMENT
We may use or disclose your PHI for law enforcement purposes to a law enforcement official, but only if certain
specified conditions are met.

DECENDENTS
We may use or disclose your PHI to a coroner, medical examiner or funeral director for identifying a deceased
person, determining a cause of death, or otherwise carrying out their duties as authorized by law.

RESEARCH
We may use or disclose your PHI for research, regardless of the source of funding the research, provided that
certain conditions are met, including but no limited to the approval of an Institutional Review Board and
consistent with applicable law.

TREATS TO HEALTH OR SAFETY
We may, consistent with applicable law and standards of ethical conduct, use or disclose your PHI if we have a
good faith belief 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 or is required by law enforcement authorities to identify or
apprehend an individual.

GOVERNMENT FUNCTIONS
We may use or disclose your PHI for the following governmental functions if certain conditions are met:
1). Military and veteran activities.
2). National security and intelligence activities.
3). Protective services for the President and others.
4). Medical suitability determination for a covered entity that is a component of the Department of State.
5). Correctional institution and other law enforcement custodial situations.
6). Covered entities that are government programs providing public benefits.

WORKMAN’S COMPENSATION
We may disclose your PHI as authorized by and to the extent necessary to comply with laws relating to workers’
compensation or other similar programs, established by law, that provide benefits for work-related injuries or
illness without regard to fault.

YOUR RIGHTS
Federal law provides you with several important right regarding your PHI. The following sections summarize your rights
and provide information regarding how to exercise them. Protecting your PHI is an important part of the services we
provide. We want to ensure that you have access to your PHI when you need it and that your clearly understand your
rights as described below.

RIGHT TO NOTICE

You have a right to adequate notice of the uses and disclosures of PHI, and our duties and responsibilities regarding
same, as provided for herein. You have a right to request a copy of this Notice.

RIGHT TO REQUEST RESTRICTIONS
You have a right to request restrictions on how we use and disclose your PHI for treatment, payment and operations, as
well as regarding those instances where you have an opportunity to agree or object. We are not required to agree to
restrictions for treatment, payment and operations except in limited circumstances. If we agree to a restriction of any
kind then we will honor it going forward, unless you take affirmative steps to revoke it or we believe, in our professional
judgement, that an emergency warrants circumventing the restriction to provide the appropriate care. In rare
circumstances, we reserve the right to terminate a restriction that we have previously agreed to, but only after providing
you a notice of termination.
You have a right to restrict certain disclosures of your PHI to a health plan where you have paid out of pocket in full for
the healthcare item or service. You are required to notify all downstream healthcare providers (e.g. a pharmacist) and
business associates, including Health Information Exchange(s), of the restriction. We are required by law to honor such
restriction and will do unless affirmatively terminated by you in writing.

RIGHT TO CONFIDENTIAL COMUNICATIONS
You have a right to request alternative communication methods with respect to your health and PHI related matters.
We ask that you make such communications requests in writing. We will honor all reasonable requests consistent with
our duty to ensure that your PHI is appropriately protected.

RIGHT TO ACCESS PHI
You have a right to access, inspect and obtain a copy of you PHI, except where excluded by applicable law(s). All
requests for access to your PHI must be made in writing. Under a limited set of circumstances, we may deny your
request. Any denial of a request to access will be communicated to you in writing.

RIGHT TO AMEND PHI
You have a right to request that we amend your PHI as long as it is maintained by us. The request must be made in
writing and you must provide a reason to support the requested amendment. Under certain conditions we may deny
your request to amend, including but not limited to, when the PHI:
1). Was not created by us.
2). Is excluded from access and inspection under applicable law.
3). Is accurate and complete.
If we accept your amendment request we will work with you to identify other healthcare stakeholders that require
notification and provide the notification. If we deny your amendment request, we will provide the rationale for denial
to you in writing and afford you the opportunity to submit a statement or disagreement.

RIGHT TO AN ACCOUNTING OF PHI DISCLOSURES
You have a right to receive an accounting of your PHI disclosures made by u during a timeframe specified by applicable
law prior to the date on which the accounting is requested. You must make any requests for an accounting in writing.
Certain PHI is excluded from an accounting by law and therefore will not be provided.

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OUR DUTIES
We are required by law to:
1. Maintain the privacy of your PHI.
2. Provide you with this Notice of our Privacy Practices.
3. Abide by the terms of the notice currently in effect.
4. Modify this Notice when there are material changes to your rights, our duties, or other practices contained herein.
This Notice will remain in effect until it is revised.
We reserve the right to change our Privacy Practices and the terms of this Notice consistent with applicable laws and our
current business processes. Should we make any revisions to this Notice, we will provide you with a notification. Any
modifications to our Notice will apply retroactively to your entire PHI, as maintained by us.
In addition to the above, we have an affirmative duty to respond to your requests in timely and appropriate manner.
We support and value your right to privacy and confidentiality and are committed to maintaining reasonable and
appropriate safeguards for your PHI. Should you decide to file a complaint with us or with the Department of Health
and Human Services, we will not retaliate in any way, shape and form.

QUESTIONS AND REQUESTS FOR INFORMATION
Questions and requests for information and other inquiries under this Notice should be directed to us as follows:
Healing Medical Group
201 E. Ogden Ave, Suite 50
Hinsdale, IL 60521
(630) 400-4194 – phone
(863) 546-4016 – fax

COMPLAINTS
If you believe that your rights have been violated, you may submit a formal written complaint to us using the contact
information provided above.

REVISIONS
We reserve the right to make modifications to our policies and procedures, including this Notice as necessary and
appropriate to comply with applicable laws, including the standards, implementation specifications, and other
requirements of the HIPPA Privacy Rule.