Covenant Integrative Wellness, LLC • Dr Sonia McGowin, DC

1022 Northeast Dr, Suite • B Jefferson City MO 65109

HIPAA NOTICE OF PRIVACY PRACTICES

This notice describes how medical information about you may be used and disclosed, and how you can access this information. Please review it carefully, and let us know if you have questions.

  1. Our pledge regarding your Protected Health Information (PHI): The privacy of your PHI is important to us. We understand that your information is personal and we are committed to protecting it. We create a record of the services you receive here. This record is needed to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways we may use and share information about you.
  2. Our legal duty:
    1. Law requires us to a) keep your medical information private; b) give you this notice describing your privacy rights, and c) follow the terms of this notice.
    2. We have the right to: change our privacy practices and the terms of this notice at any time, provided that the changes are permitted by law; b) make changes in our privacy practices and the new terms of our notice effective for all PHI that we keep, including information previously created or received before the changes.
    3. Notice of changes to privacy practices: before we make an important change in our privacy practices, we will change this notice and make the new notice available upon request.
  3. Use and disclosure of your medical information:

The following section describes the different ways that we may use and disclose PHI. Not every disclosure is listed. We will not use or disclose your PHI for any purpose not listed below, without your specific written authorization. Any specific authorization can be revoked by you at any time.

For treatment: we may use PHI about you to provide you with treatment or services. We may also disclose information to doctors, nurses, etc., who are also taking care of you.

Notification: To notify a family member or other person responsible for your care.

Public Health Activities: As required by law, we may disclose your medical information to public health or legal authorities charged with preventing or controlling disease, injury or disability, including child abuse or neglect.

Law Enforcement: under certain circumstances, we may disclose PHI to law enforcement officials.

  1. Your individual rights:

You have the right to:

  1. Look at or get copies of your PHI. To receive copies, you must make your request in writing and agree to pay $.50 per page plus postage.
  2. Receive a list of all the times we share your PHI for purposes other than treatment and other specified exceptions.
  3. Request that we place additional restrictions on our use or disclosure of your PHI. We are not required to agree to these additional restrictions, but if we do, we will abide by them.
  4. Request that we communicate with you about your PHI by different means. You must make this request in writing.
  5. Request that we change your PHI. We may deny your request if we did not create the information you are requesting be changed. If we deny your request, you will be notified of the reasons in writing.

Questions & Complaints:

If you have questions about this notice, or if you think we may have violated your privacy rights, please contact us. You may also submit a written complaint to the US Department of Health and Human Services. We will not retaliate in any way if you file a complaint.