NOTICE OF PRIVACY PRACTICES

Signature Providers Nursing Corp.

www.spproviders.com

contact@spproviders.com

PH (888) 848-4364

Fax (559) 423-5104

September 16, 2024

This notice went into effect on 9/16

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

I. SIGNATURE PROVIDERS NURSING CORP.’S PLEDGE REGARDING HEALTH INFORMATION:

Signature Providers Nursing Corp. understands that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. This record is needed to provide you with quality care and to comply with certain legal requirements. This notice applies to all records of your care generated by our mental health care practice.

This notice will tell you about the ways in which we may use and disclose health information about you. We will also describe your rights regarding the health information we keep about you and our obligations regarding its use and disclosure.

We are required by law to:

• Make sure that protected health information (“PHI”) that identifies you is kept private.

• Give you this notice of our legal duties and privacy practices with respect to health information.

• Follow the terms of the notice that is currently in effect.

• Signature Providers Nursing Corp. may change the terms of this Notice, and such changes will apply to all information we have about you. The new Notice will be available upon request, in our office, and on our website.

II. HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU:

The following categories describe different ways that we use and disclose health information. For each category, we will explain the use and give examples.

For Treatment, Payment, or Health Care Operations:

Federal privacy rules allow health care providers who have a direct treatment relationship with the patient/client to use or disclose PHI without the patient’s written authorization to carry out treatment, payment, or health care operations. We may also disclose your PHI for the treatment activities of any health care provider.

For example, if a clinician consults with another licensed health care provider about your condition, we would be permitted to use and disclose your PHI to assist with the diagnosis and treatment of your mental health condition.

Disclosures for treatment purposes are not limited to the minimum necessary standard. Health care providers need access to the full record and complete information to provide quality care. “Treatment” includes coordination of care, consultations, and referrals between health care providers.

Lawsuits and Disputes:

If you are involved in a lawsuit, we may disclose health information in response to a court or administrative order. We may also disclose information in response to a subpoena, discovery request, or other lawful process, but only if efforts have been made to notify you or obtain an order protecting the requested information.

III. CERTAIN USES AND DISCLOSURES REQUIRE YOUR AUTHORIZATION:

1. Psychotherapy Notes: We keep “psychotherapy notes” as defined in 45 CFR § 164.501, and any use or disclosure of such notes requires your Authorization, unless:

   • We use them for treatment.

   • We use them for training or supervision of mental health practitioners.

   • We use them to defend ourselves in legal proceedings initiated by you.

   • Required by law, including health oversight activities or coroner’s investigations.

2. Marketing Purposes: Signature Providers Nursing Corp. will not use or disclose your PHI for marketing purposes.

3. Sale of PHI: We will not sell your PHI in the regular course of business.

IV. CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION:

We may use or disclose your PHI without your authorization in the following circumstances:

• When required by state or federal law.

• For public health activities (e.g., reporting abuse or threats to health and safety).

• For health oversight activities, such as audits and investigations.

• For judicial proceedings, such as court orders.

• For law enforcement purposes, including reporting crimes on our premises.

• To coroners or medical examiners.

• For research purposes.

• For government functions, including military operations and correctional institutions.

• For workers’ compensation purposes.

V. CERTAIN USES AND DISCLOSURES REQUIRE YOU TO HAVE THE OPPORTUNITY TO OBJECT:

We may disclose your PHI to family, friends, or others involved in your care or payment for care unless you object. This opportunity to consent may be obtained retroactively in emergencies.

VI. YOUR RIGHTS WITH RESPECT TO YOUR PHI:

1. The Right to Request Limits on Uses and Disclosures of Your PHI.

2. The Right to Request Restrictions for Out-of-Pocket Expenses Paid in Full.

3. The Right to Choose How We Contact You.

4. The Right to See and Get Copies of Your PHI.

5. The Right to Get a List of Disclosures We Have Made.

6. The Right to Correct or Update Your PHI.

7. The Right to Get a Copy of This Notice.

Acknowledgement of Receipt of Privacy Notice
Under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you have certain rights regarding the use and disclosure of your protected health information. By checking the box below, you acknowledge that you have received a copy of this HIPAA Notice of Privacy Practices.

BY SIGNING THIS NOTICE, YOU AGREE THAT YOU HAVE READ, UNDERSTOOD, AND AGREE TO THE ITEMS CONTAINED IN THIS DOCUMENT.