THIS NOTICE DESCRIBES HOW MEDICAL/MENTAL HEALTH INFORMATION ABOUT YOU MAY BE

USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW IT CAREFULLY.

January 1^st, 2005

LifeCoach Network, LLC is required by law to protect the privacy of your health information. LifeCoach Network only releases information in accordance with state and federal laws and the ethics of the behavioral healthcare profession. We are also required to provide you with this notice, which explains how we may use information about you and when we can give out or "disclose" that information to others. You also have rights regarding your health information that are described in this notice.

 

The terms “information” or “health information” in this notice include any personal information that is created or received

by a health care provider or health plan that relates to your physical or mental health or condition, the provision of health

care to you, or the payment for such health care. We have the right to change our privacy practices. If we do, we will provide the revised notice to you within 60 days by direct mail or post it on our website.

How We Use or Disclose Information

We must use and disclose your health information to provide information:

·         To you or someone who has the legal right to act for you (your personal representative);

·         To the Secretary of the Department of Health and Human Services, if necessary, to make sure your        privacy is protected; and

·         Where required by law.  

We have the right to use and disclose health information to provide, coordinate or manage your health care and operate our business. For example, we may use your health information:

·         For Payment.  We may use and disclose your protected health information to obtain payment for the health care services LifeCoach Network provides you. For example, LifeCoach Network may include information with a bill to a third-party payer that identifies you, your diagnosis, and services provided

·         For Treatment.  LifeCoach Network may use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. LifeCoach Network may also disclose your health information to other health care providers who may be treating you.

·         For Health Care Operations. We may use or disclose health information as necessary to operate and manage our business and to help you benefit from the services provided. For example, we might talk to your provider to suggest a program that could help improve your health.

·         To Provide Information on Health Related Programs or Products such as alternative treatments and programs or about health related products and services.

·         To Plan Sponsors. If your coverage is through an employer group health plan, we may share summary health information and enrollment and disenrollment information with the plan sponsor.

·         For Appointment Reminders. We may use health information to contact you for appointment reminders with providers who provide care to you.

 

We may use or disclose your health information for the following purposes under limited circumstances:

·         To Persons Involved With Your Care. We may use or disclose your health information to a person involved in your care, such as a family member, when you are incapacitated or in an emergency, or when permitted by law.

·         For Public Health Activities such as reporting disease outbreaks.

·         For reporting victims of abuse, neglect or domestic violence to government authorities, including a social service or protective service agency.

·         For Health Oversight Activities such as governmental audits and fraud and abuse investigations.

·         For Judicial or Administrative Proceedings such as in response to a court order, search warrant or subpoena.

·         For Law Enforcement Purposes such as providing limited information to locate a missing person.

·         To Avoid a Serious Threat to Health or Safety by, for example, disclosing information to public health agencies.

·         For Specialized Government Functions such as military and veteran activities, national security and intelligence activities, and the protective services for the President and others.

·         For Research Purposes such as research related to the prevention of disease or disability, if the research study meets all privacy law requirements.

 

If none of the above reasons apply, then we must get your written authorization to use or disclose your health information.

 

If a use or disclosure of health information is prohibited or materially limited by other applicable law, it is our

intent to meet the requirements of the more stringent law. In some states, your authorization may also be required for

disclosure of your health information. In many states, your authorization may be required in order for us to disclose your highly confidential mental health information, as described below. Once you give us authorization to release your health information, we cannot guarantee that the person to whom the information is provided will not disclose the information. You may take back or "revoke" your written authorization, except if we have already acted based on your authorization.

 

What Are Your Rights

The following are your rights with respect to your health information.

You have the right to ask to restrict uses or disclosures of your information for treatment, payment, or health care

operations. You also have the right to ask to restrict disclosures to family members or to others who are involved in

your health care or payment for your health care. We may also have policies on dependent access that may authorize

certain restrictions. Please note that while we will try to honor your request and will permit requests consistent with our policies, we are not required to agree to any restriction.

 

·         You have the right to ask to receive confidential communications of information in a different manner or at a different place (for example, by sending information to a P.O. Box instead of your home address).

·         You have the right to see and obtain a copy of health information that may be used to make decisions about you such as claims and case or care management records. You also may receive a summary of this health information. You must make a written request to inspect and copy your health information. In certain limited circumstances, we may deny your request to inspect and copy your health information.

·         You have the right to ask to amend information we maintain about you if you believe the health information about you is wrong or incomplete. If we deny your request, you may have a statement of your disagreement added to your health information.

·         You have the right to receive an accounting of disclosures of your information made by us during the six years prior to your request. This accounting will not include disclosures of information: (i) made prior to April 14, 2003; (ii) for treatment, payment, and health care operations purposes; (iii) to you or pursuant to your authorization; and (iv) to correctional institutions or law enforcement officials; and (v) other disclosures that federal law does not require us to provide an accounting.

·         You have the right to a paper copy of this notice. You may ask for a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice on this website.

Exercising Your Rights

·         Contacting your Provider. If you have any questions about this notice or want to exercise any of your rights, please email security@sleepcoach.net. Please specify that your question or concern is in regards to your LifeCoach Network Service.
 

·         Filing a Complaint. If you believe your privacy rights have been violated, you may file a complaint with us at the following address:

LifeCoach Network

Compliance Department

Privacy Complaints

7791 Byron Center Ave

Byron Center,  MI 49315

 

·   You may also notify the Secretary of the U.S. Department of Health and Human Services of your complaint.