Notice of Privacy Practices
Effective Date: 3/1/2016
Chief Privacy Officer: Elizabeth Kelly
Email: [email protected]
Phone: (312) 380-9638
This notice describes how medical information about you and your child may be used and disclosed and how you can get access to this information. Please review it carefully. The privacy of your health information is important to us.
How Third Coast Lactation LLC May Use or Disclose the Health Information of You and Your Child:
For Treatment. Third Coast Lactation LLC may use your health information to provide you with medical treatment or services and to record the results of the treatments or services.
For Payment. Third Coast Lactation LLC may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive, such as to an insurance company or health plan.
For Health Care Operations. Third Coast Lactation LLC may use and disclose health information about you to staff members for operational purposes, such as to evaluate the performance of our staff, assess the quality of care and outcomes, and learn how to improve our services. Third Coast Lactation LLC may also disclose your name and address to a trusted emergency contact (i.e., a spouse, etc.), to provide a measure of security to the lactation consultant doing home visits.
To Health Care Providers. Third Coast Lactation LLC may disclose health information to third party health care providers, such as your midwife, family MD, pediatrician, NP, or OB for their treatment, payment, or operational purposes.
Appointments. Third Coast Lactation LLC may use your information to provide appointment reminders or information about alternatives or other services that may be of interest to you.
Required by law; for Health and Safety. Third Coast Lactation LLC may use and disclose information about you as required by law. For example, for judicial and administrative proceedings pursuant to legal authority; to report information related to suspected victims of abuse, neglect, domestic violence, or other crimes; to avert a serious threat to the health or safety of you or any other person; and to assist law enforcement officials in their duties.
Your Authorization. In addition to our use of your health information for treatment, payment, or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this notice.
Your Health Information Rights
You have the right to:
o Request/Inspect a copy of your health record (as defined by the HIPAA Privacy Standards);
o Request a restriction on certain uses and disclosures or your information as provided by the HIPAA Privacy Standards; however, Third Coast Lactation LLC is not required to agree to a requested restriction;
o Obtain a paper copy of the notice of information practices upon request;
o Request amendments to your health record (as required by the HIPAA Privacy Standards);
o Request communications of your health information by alternative means or at alternative locations; and
o Receive a list of disclosures made of your health information (as required by the HIPAA Privacy Standards).
We may charge you a reasonable cost-based fee for expenses such as copies and staff time and postage, as permitted by law.
Complaints: You may complain to Third Coast Lactation LLC at the contact information below, or to the US Department of Health and Human Services, if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.
Obligations of Third Coast Lactation LLC
Third Coast Lactation LLC is required by law to:
o Maintain the privacy of protected health information;
o Notify you of its legal duties and privacy practices with respect to your health information;
o Follow the terms of this notice;
o Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
o Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations.
Third Coast Lactation LLC reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains.
Contact Information
If you have any questions or complaints, please call (312) 380-9638 or email [email protected].
Revised notices will be made available to you upon request and on our website.
How Third Coast Lactation LLC May Use or Disclose the Health Information of You and Your Child:
For Treatment. Third Coast Lactation LLC may use your health information to provide you with medical treatment or services and to record the results of the treatments or services.
For Payment. Third Coast Lactation LLC may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive, such as to an insurance company or health plan.
For Health Care Operations. Third Coast Lactation LLC may use and disclose health information about you to staff members for operational purposes, such as to evaluate the performance of our staff, assess the quality of care and outcomes, and learn how to improve our services. Third Coast Lactation LLC may also disclose your name and address to a trusted emergency contact (i.e., a spouse, etc.), to provide a measure of security to the lactation consultant doing home visits.
To Health Care Providers. Third Coast Lactation LLC may disclose health information to third party health care providers, such as your midwife, family MD, pediatrician, NP, or OB for their treatment, payment, or operational purposes.
Appointments. Third Coast Lactation LLC may use your information to provide appointment reminders or information about alternatives or other services that may be of interest to you.
Required by law; for Health and Safety. Third Coast Lactation LLC may use and disclose information about you as required by law. For example, for judicial and administrative proceedings pursuant to legal authority; to report information related to suspected victims of abuse, neglect, domestic violence, or other crimes; to avert a serious threat to the health or safety of you or any other person; and to assist law enforcement officials in their duties.
Your Authorization. In addition to our use of your health information for treatment, payment, or healthcare operations, you may give us written authorization to use your health information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your health information for any reason except those described in this notice.
Your Health Information Rights
You have the right to:
o Request/Inspect a copy of your health record (as defined by the HIPAA Privacy Standards);
o Request a restriction on certain uses and disclosures or your information as provided by the HIPAA Privacy Standards; however, Third Coast Lactation LLC is not required to agree to a requested restriction;
o Obtain a paper copy of the notice of information practices upon request;
o Request amendments to your health record (as required by the HIPAA Privacy Standards);
o Request communications of your health information by alternative means or at alternative locations; and
o Receive a list of disclosures made of your health information (as required by the HIPAA Privacy Standards).
We may charge you a reasonable cost-based fee for expenses such as copies and staff time and postage, as permitted by law.
Complaints: You may complain to Third Coast Lactation LLC at the contact information below, or to the US Department of Health and Human Services, if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.
Obligations of Third Coast Lactation LLC
Third Coast Lactation LLC is required by law to:
o Maintain the privacy of protected health information;
o Notify you of its legal duties and privacy practices with respect to your health information;
o Follow the terms of this notice;
o Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;
o Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations.
Third Coast Lactation LLC reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains.
Contact Information
If you have any questions or complaints, please call (312) 380-9638 or email [email protected].
Revised notices will be made available to you upon request and on our website.
