HIPAA Privacy Notice
Healthy Sprouts and House Calls, PLLC
Your Information, Rights, and Responsibilities
This policy will review how your medical information may be used and disclosed and how you can get access to your health information. Please review.
You can ask to see and/or get an electronic or paper copy of your medical record and other health information. Please ask how this can be done.
We will provide a copy or summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
You can ask us to correct health information about you that you think is incorrect or incomplete. You should make this request in writing by email or US postal service mail.
We may decline your request, but we will tell you why in writing within 60 days. You can ask us to contact you in a specific way, for example, your home or mobile phone. Or maybe you want mail sent to a different address. Reasonable requests will be honored.
You can ask us NOT to share or use certain health information for treatment , payment or our operations. We are not required to agree with your request and we may say no if it would affect your care.
If you self-pay for service or health care items in full (out-of-pocket/ don’t use insurance) you can ask us not to share that information for the purpose of payment or our operation with your health insurer. We will say yes unless a specific law prevents us from doing so.
You can ask for a list of the times we have shared you health information for six years prior to the date you ask, who we shared it with and why. We will include all disclosures except those regarding payment and health care operations, or disclosures requested by you. We will provide the disclosures for a period of one year for free. If you desire additional years(up to 6 years past the effective date of this notice) this will be provided for a reasonable charge.
You can ask for a paper copy of this notice at any time. You can get this notice electronically from our website.
If you have given someone medical power of attorney or if someone is your legal guardian, they can exercise your rights and make choices about your health information.
We will confirm that his person has this authority and can act for you before fulfilling any requests.
You can file a complaint if you feel your rights were violated with the US Department of Health and Human Services Office of Civil Rights by sending a letter to
200 Independence Avenue, S.W. Washington, D.C. 20201,
or calling 1-877-696-6775
Or by visiting
We will not retaliate against you for filing a complaint.
You have the right and choice to ask us to do the following:
Share information with your family, close friends, and others involved in your care, share information in a disaster relief situation.
If you are not able to tell us your preference, for example, if you are unconscious, we may share your information if we believe it is in your best interest. We may also share information to lessen a serious and imminent threat to your health and safety.
We do not share your health information for marketing purposes or sell your information. We do not produce or share psychotherapy notes.
We will not contact you for fund-raising of any sort.
We do not create or manage hospital directories.
We use or share your health information with other professionals who are treating you, i.e. your primary care doctor or if you need to go to the emergency department following our visit.
We can use and share your health information to improve your care, run our practice, and contact you if necessary.
We can use and share your health information to bill and get payment from health plans for our services.
We can share health information about you for certain situations such as the following:
Preventing communicable diseases, for product recalls, for adverse reactions to medications, if reporting abuse, neglect or domestic violence or in prevention of a serious threat to anyone’s health and safety.
If we share your information for public health and research purposes , we must meet many conditions in the law before we can share your information.
We will share your health information if state or federal law requires, including with the Department of Health and Human Services if they want to see that we are complying with federal privacy law.
We can share health information with a coroner or medical director/funeral director in accordance with the law.
We can share health information for worker’s compensation claims, for law enforcement purposes with a law enforcement official, health oversight agencies for activities authorized by law.
We can share your health information in response to a court or administrative order or in response to a subpoena.
We are required by law to maintain the privacy and purity of your protected health information.
We will let you know promptly if a breach occurs which may compromise the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and offer you a copy.
We will not use or share your information in any other way other than described in this document unless you tell us in writing to do something differently. You can change your mind at any time. Please let us know in writing if you change your mind.
Effective date of HIPAA policy 03/01/2020
Contact the Privacy Officer
Email: [email protected]
Attention Privacy Officer
3966 Bloomingdale Road
Kingsport, TN 37660