Privacy Notice

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

A. Novia CareClinics, LLC's commitment to your privacy:

Novia CareClinics, LLC ("Novia") is dedicated to maintaining the privacy of your individually identifiable health information (also called "protected health information" or "PHI"). In conducting our business, we will create records regarding you and the treatment and services we provide to you. We are required by law to maintain the confidentiality and privacy of your protected health information. We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain at Novia concerning your protected health information. By federal and state law, we must abide by the terms of the Notice of Privacy Practices (the "Notice") that we have in effect at the time.

We realize that these laws are complicated, but we must provide you with the following important information:

  1. How Novia may use and disclose your protected health information;
  2. Your privacy rights in your protected health information; and
  3. Our obligations concerning the use and disclosure of your protected health information.

The terms of this notice apply to all records containing your protected health information that are created or retained by Novia. We reserve the right to change or amend this Notice. Any revision or amendment to this Notice will be effective for all of your records that Novia has created or maintained in the past, and for any of your protected health information that we may create or maintain. Novia will post a copy of our current Notice in the clinic we operate in a visible location at all times and at www.noviacareclinics.com and you may request a copy of our most current Notice at any time.

B. Protected health information is not released to Employers.

The protected health information of an employee, eligible dependent, or other designated participant of an employer that has contracted with Novia for the operation of a primary health clinic for the employer will be kept confidential by Novia. Under no circumstances will the protected health information be furnished or made available to the employer. Your personal wellness report, which may include protected health information, is available to you on NoviaPWR.com and under no circumstances will be made available or accessible by your employer.

C. Privacy Officer

If you have questions about this Notice, please contact Jeremy York at Novia CareClinics, LLC via telephone at 1-800-897-4093 or in writing at Novia CareClinics, LLC, 429 North Pennsylvania Street, Suite 400, Indianapolis, Indiana, 46204.

D. We may use and disclose your protected health information in the following ways:

Your protected health information may be used and disclosed by your physician, nurse practitioner, physician assistant, our office staff and others outside Novia who are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to support the operation of clinics by Novia. Following are examples of the types of uses and disclosures that may be made by Novia.

Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with another provider. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.    

Payment: Your protected health information may be used and disclosed, as needed, to obtain payment from your employer's health benefits plan for your health care services provided by another provider. This may include certain activities that your employer's health benefits plan may undertake before it approves or pays for the health care services recommended for you by such other provider, such as: making a determination of eligibility as an employee, eligible dependent of an employee, or other designated participant of an employer. Notwithstanding this, under no circumstances will Novia disclose your protected health information to your employer.

Health Care Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of Novia. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing and conducting, or arranging for other business activities.

We will share your protected health information with third party "business associates" that perform various activities (for example, diagnostic imaging or laboratory services) for Novia. Whenever an arrangement between Novia and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.

Notwithstanding this, under no circumstances will Novia disclose your protected health information to your employer.

Appointment reminders: Novia may use and disclose your protected health information to contact you and remind you of an appointment. This contact may include contact through the registered-user-only area of www.NoviaPWR.com.

Treatment options: Novia may use and disclose your protected health information to inform you of potential treatment options or alternatives.

Health-related benefits and services: Novia may use and disclose your protected health information to inform you of health-related benefits or services that may be of interest to you.

Release of information to family/friends: Unless you object, Novia may release your protected health information to a friend or family member that is involved in your care or who assists in taking care of you. For example, a parent or guardian may ask that a baby sitter take their child to the pediatrician's office for treatment of a cold. In this example, the baby sitter may have access to this child's medical information.

Disclosures required by law: Novia will use and disclose your PHI when we are required to do so by federal, state, or local law.

E. Use and disclosure of your PHI in certain special circumstances:

The following categories describe unique scenarios in which we may use or disclose your protected health information:

Public health risks: Novia may disclose your protected health information to public health authorities that are authorized by law to collect or receive information. For example, a disclosure may be made for the purposes of preventing or controlling disease, injury or disability or reporting child abuse or neglect.

Health oversight activities: Novia may disclose your protected health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure, and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws, and the health care system in general.

Lawsuits and similar proceedings: Novia may use and disclose your protected health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your PHI in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.

Law enforcement: We may release protected health information if asked to do so by a law enforcement official:

  1. Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement;
  2. Concerning a death we believe has resulted from criminal conduct;
  3. Regarding criminal conduct at a Novia healthcare clinic or our offices;
  4. In response to a warrant, summons, court order, subpoena, or similar legal process;
  5. To identify/locate a suspect, material witness, fugitive, or missing person;
  6. In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity, or location of the perpetrator).

Deceased patients: Novia may release PHI to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.

Organ and tissue donation: Novia may release your PHI to organizations that handle organ, eye, or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.

Research: Novia may use and disclose your PHI for research purposes in certain limited circumstances. We will obtain your written authorization to use your PHI for research purposes except when an Internal Review Board or Privacy Board has determined that the waiver of your authorization satisfies all of the following conditions:

(A) The use or disclosure involves no more than a minimal risk to your privacy based on the following: (i) an adequate plan to protect the identifiers from improper use and disclosure; (ii) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (iii) adequate written assurances that the PHI will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted;

(B) The research could not practicably be conducted without the waiver,

(C) The research could not practicably be conducted without access to and use of the PHI.

Reports on Use and Effectiveness of Clinic: One of the principal reasons your employer has decided to provide a clinic operated by Novia is to improve the health of you and the other employees. Under HIPAA, it is permissible for Novia to use personal health information to compile general reports on the use and effectiveness of the clinic for your employer as long as Novia removes any individually identifiable information from the reports. Any such reports prepared by Novia for your employer will comply with HIPAA. As stated elsewhere, under no circumstances will Novia disclose your protected health information to your employer.

Serious threats to health or safety: Novia may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

Military: Novia may disclose your PHI if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

National security: Novia may disclose your PHI to federal officials for intelligence and national security activities authorized by law. We also may disclose your PHI to federal and national security activities authorized by law. We also may disclose your PHI to federal officials in order to protect the president, other officials or foreign heads of state, or to conduct investigations.

Inmates: Novia may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

Workers' compensation: Novia may disclose your protected health information as authorized to comply with workers' compensation laws and other similar legally-established programs.

F. Your rights regarding your protected health information:

You have the following rights regarding the protected health information that we maintain about you:

Confidential communications: You have the right to request that Novia communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that we contact you at home, rather than work. In order to request a type of confidential communication, you must make a written request to Jeremy York at Novia CareClinics, LLC, 429 North Pennsylvania Street, Suite 400, Indianapolis, Indiana, 46204, specifying the requested method of contact or the location where you wish to be contacted. Novia will accommodate reasonable requests. You do not need to give a reason for your request.

Requesting restrictions: You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment, or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law and in emergencies when the information is necessary to provide the emergency treatment. In order to request a restriction in our use or disclosure of your PHI, you must make your request in writing to Jeremy York at Novia CareClinics, LLC, 429 North Pennsylvania Street, Suite 400, Indianapolis, Indiana, 46204. Your request must describe in a clear and concise fashion:

  1. The information you wish restricted;
  2. Whether you are requesting to limit Novia's use, disclosure, or both; and,
  3. To whom you want the limits to apply.

Inspection and copies: You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. You must submit your request in writing to Jeremy York at Novia CareClinics, LLC, 429 North Pennsylvania Street, Suite 400, Indianapolis, Indiana, 46204, in order to inspect and/or obtain a copy of your PHI. Novia may charge a fee for the costs of copying, postage, and time involved in preparing an explanation or summary of the protected health information, if applicable. Novia may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional designated by Novia that was not directly involved with the denial will conduct reviews.

You may download and print your personal wellness report, which may include protected health information, that you have access to by accessing the registered-user-only area of NoviaPWR.com.

Amendment: You may ask us to amend your protected health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for Novia. To request an amendment, your request must be made in writing and submitted to Jeremy York at Novia CareClinics, LLC, 429 North Pennsylvania Street, Suite 400, Indianapolis, Indiana, 46204. You must provide us with a reason that supports your request for amendment. Novia will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the PHI kept by or for Novia; (c) not part of the PHI which you would be permitted to inspect; or (d) not created by Novia, unless the individual or entity that created the information is not available to amend the information.

You may also amend portions of your protected health information available to you on your personal wellness report in the registered-user-only area of NoviaPWR.com.

Right to Receive an Accounting of Certain Disclosures We Have Made, If Any: All of our patients have the right to request an "accounting of disclosures." An "accounting of disclosures" is a list of certain non-routine disclosures Novia has made of your protected health information for purposes not related to treatment, payment, or health care operations. Use of your protected health information as part of the routine patient care provided in a clinic operated by Novia is not required to be documented for example, the doctor sharing information with the nurse. In order to obtain an accounting of disclosures, you must submit your request in writing to Jeremy York at Novia CareClinics, LLC, 429 North Pennsylvania Street, Suite 400, Indianapolis, Indiana, 46204. All requests for an "accounting of disclosures" must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003. The first list you request within a 12-month period is free of charge, but Novia may charge you a reasonable, cost based fee for additional lists within the same 12-month period. Novia will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs.

Right to a paper copy of this notice: You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Jeremy York at Novia CareClinics, LLC via telephone at 1-800-897-4093 or in writing at Novia CareClinics, LLC, 429 North Pennsylvania Street, Suite 400, Indianapolis, Indiana, 46204.

Right to file a complaint: If you believe your privacy rights have been violated, you may file a complaint with Novia and the Secretary of the Department of Health and Human Services. To file a complaint with Novia, contact Jeremy York at Novia CareClinics, LLC via telephone at 1-800-897-4093 or in writing at Novia CareClinics, LLC, 429 North Pennsylvania Street, Suite 400, Indianapolis, Indiana, 46204. All complaints must be submitted in writing. You will not be penalized or retaliated against for filing a complaint.

Right to provide an authorization for other uses and disclosures: Novia will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your PHI may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note: We are required to retain records of your care.

Again, if you have any questions regarding this notice or our health information privacy policies, please contact Jeremy York at Novia CareClinics, LLC via telephone at 1-800-897-4093 or in writing at Novia CareClinics, LLC, 429 North Pennsylvania Street, Suite 400, Indianapolis, Indiana, 46204.

This Notice was published and became effective on January 7, 2009.

As required by the privacy regulations created as a result of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).    

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