Privacy Policies

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. My Pledge Regarding Confidential Information:

I understand that information about you and your care is personal. I am committed to protecting confidential information about you. I create a record of the care and services you receive from me. I need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by this practice. This notice will tell you about the ways in which I may use and disclose health information about you. I also describe your rights to the health information I keep about you and describe certain obligations I have regarding the use and disclosure of your health information. I am required by law to:

• Make sure that confidential information that identifies you is kept private.
• Give you this notice of my legal duties and privacy practices with respect to health information.
• Follow the terms of the notice that is currently in effect.
• I can change the terms of this Notice, and such changes will apply to all information I have about you. The new Notice will be available upon request, in my office, and on my website.

II. How I May Use and Disclose Health Information About You:

The following categories describe different ways that I use and disclose confidential information. For each category of uses or disclosures I will explain what I mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all the ways I am permitted to use and disclose information will fall within one of the categories.

Disclosures for coaching purposes are not limited to the minimum necessary standard.

Lawsuits and Disputes: If you are involved in a lawsuit, I may disclose private information in response to a court or administrative order. I may also disclose coaching information about your child in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

III. Certain Uses and Disclosures Require Your Authorization:

1. Session Notes: I do keep “Session notes” and any use or disclosure of such notes requires your Authorization unless the use or disclosure is:
   
   1. For my use in coaching my clients, jointly or individually.
   2. For my use in training or supervising associates to help them improve their mother- daughter coaching skills.
   3. For my use in defending myself in legal proceedings instituted by you.
   4. For use by the Secretary of Health and Human Services to investigate my compliance with HIPAA.
   5. Required by law and the use or disclosure is limited to the requirements of such law.
   6. Required by law for certain health oversight activities pertaining to the originator of the session notes.
   7. Required by a coroner who is performing duties authorized by law.
   8. Required to help avert a serious threat to the health and safety of others.
2. Marketing Purposes. NO WAY!! As a mother-daughter coach, I WILL NOT use or disclose your confidential information for marketing purposes.
3. Sale of confidential. NO WAY!! As a mother-daughter coach, I will not sell your confidential information in the regular course of my business.

IV. Certain Uses and Disclosures Do Not Require Your Authorization.

Subject to certain limitations in the law, I can use and disclose your confidential information without your Authorization for the following reasons:

1. When disclosure is required by state or federal law, and the use or disclosure complies with and is limited to the relevant requirements of such law.
2. For public health activities, including reporting suspected child, elder, or dependent adult abuse, or preventing or reducing a serious threat to anyone’s health or safety.
3. For health oversight activities, including audits and investigations.
4. For judicial and administrative proceedings, including responding to a court or administrative order, although my preference is to obtain an Authorization from you before doing so.
5. For law enforcement purposes, including reporting crimes occurring on my premises.
6. To coroners or medical examiners, when such individuals are performing duties authorized by law.
7. Specialized government functions, including, ensuring the proper execution of military missions; protecting the President of the United States; conducting intelligence or counterintelligence operations; or helping to ensure the safety of those working within or housed in correctional institutions.
8. For workers’ compensation purposes. Although my preference is to obtain an Authorization from you, I may provide your PHI to comply with workers’ compensation laws.
9. Appointment reminders and coaching-related benefits or services. I may use and disclose your confidential information to contact you to remind you that you have an appointment with me. I may also use and disclose your confidential information to tell you about treatment alternatives.

V. Certain Uses and Disclosures Require You to Have the Opportunity to Object.

1. Disclosures to family, friends, or others. I may provide your confidential information to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

VI. You Have the Following Rights with Respect to Your Confidential Information:

1. The Right to Request Limits on Uses and Disclosures of Your Confidential Information. You have the right to ask me not to use or disclose certain confidential information for coaching, payment, or operations purposes. I am not required to agree to your request, and I may say “no” if I believe it would affect your overall health.
2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid for In Full. You have the right to request restrictions on disclosures of your private information if your coaching is being paid for by a third party.
3. The Right to Choose How I Send Confidential Information to You. You have the right to ask me to contact you in a specific way (for example, home or office phone) or to send mail to a different address, and I will agree to all reasonable requests.
4. The Right to See and Get Copies of Your Confidential Information. Other than “session notes,” you have the right to get an electronic or paper copy of your entire record or any part thereof. I will provide you with a copy of your record, or a summary of it, if you agree to receive a summary, within 30 days of receiving your written request. There is a flat fee of

$75 to obtain a copy of your records, regardless the number of pages.

1. The Right to Get a List of the Disclosures I Have Made. You have the right to request a list of instances in which I have disclosed your confidential information for purposes other than treatment, payment, or health care operations, or for which you provided me with an Authorization. I will respond to your request for an accounting of disclosures within 60 days of receiving your request. The list I will give you will include disclosures made in the last six years unless you request a shorter time. I will provide the list to you at no charge, but if you make more than one request in the same year, I will charge you a flat fee of $75 for each additional request.
2. The Right to Correct or Update Your Confidential Information. If you believe that there is a mistake in your confidential information, or that a piece of important information is missing from your confidential information, you have the right to request that I correct the existing information or add the missing information. I may say “no” to your request, but I will tell you why in writing within 60 days of receiving your request.
3. The Right to Get a Paper or Electronic Copy of this Notice. You have the right get a paper copy of this Notice, and you have the right to get a copy of this notice by e-mail. And, even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of it.

If you have any questions about the terms of this Notice of Privacy Practices for Vita Nova Mother- Daughter Coaching, please feel free to reach out with the following contact information:

Vita Nova Mother-Daughter Coaching, LLC

Erica Thomas, Certified Mother-Daughter Coach Trained By MDCI (512) 777-0899

erica@vitanovamotherdaughtercoaching.com