Sunflower Clinic
Notice of Privacy Practices
Your privacy matters to us. This Notice of Privacy Practices describes how Sunflower Clinic may use and disclose your protected health information (PHI), and the rights you have over your own records. We are required by law to maintain the privacy of your health information, to provide you with this Notice, and to follow its terms.
If you have any questions about this Notice or how your information is handled, contact our Privacy Officer at 717-208-2889 or compliance@sunflowerclinic.com.
This Notice describes how your protected health information (PHI) may be used and disclosed and explains your rights. Please review it carefully.
If you have questions, contact:
Sunflower ClinicAnna Borysova, Privacy Officer
4322 Buckingham Rd. Royal Oak Mi 48073
717-208-2889
compliance@sunflowerclinic.com
Confidentiality Protections
Under federal and state law, mental health and substance use treatment records are confidential and may not be disclosed without your written consent, except as permitted or required by law.
Records relating to substance use disorder diagnosis, treatment, or referral for treatment are protected under federal law (42 CFR Part 2) and may not be disclosed without your written consent except as specifically permitted by law.
Our Pledge Regarding Protected Health Information
We, Sunflower Clinic, understand that protected health information about you and your health is personal. We are committed to protecting health information about you. This Notice applies to all PHI maintained by Sunflower Clinic.
We are required to follow the terms of the Notice currently in effect and to notify you if a breach of your unsecured PHI occurs.
When using or disclosing your PHI, we will limit the information to the minimum necessary to accomplish the intended purpose, except for treatment purposes or as otherwise required by law.
We reserve the right to update this Notice at any time. Any changes will apply to all PHI we maintain and will be posted in our office and on our website, with copies available upon request.
How We Use and Disclose Information
We may use or disclose your protected health information (PHI) without your written authorization in the following circumstances:
Treatment
We may use or share your PHI to provide, coordinate, or manage your care, including communicating with other healthcare providers involved in your treatment and contacting you about appointments.
Payment
We may use or disclose your PHI to bill and collect payment for services, including sharing information with insurance companies or other payers as necessary to obtain payment.
Healthcare Operations
We may use or disclose your PHI for activities necessary to operate our practice, including quality improvement, case management, care coordination, and compliance activities. We may use de-identified information for internal evaluation and improvement.
As Required by Law
We will disclose PHI when required by federal, state, or local law.
Research
We may disclose PHI for research purposes when approved by an institutional review board or privacy board in accordance with applicable law.
Abuse, Neglect, and Threats to Safety
We may disclose PHI if we reasonably believe you are a victim of abuse, neglect, or domestic violence, or if necessary to prevent or lessen a serious and imminent threat to your health or safety or that of another person, as permitted or required by law.
Legal Proceedings
We may disclose PHI in response to a court order, subpoena, or other lawful process, as permitted by law.
Business Associates
We may share PHI with third-party service providers who perform services on our behalf. These entities are required to safeguard your information.
Public Health
We may disclose PHI to public health authorities as required by law.
Health Oversight
We may disclose PHI to government agencies for oversight activities authorized by law.
Law Enforcement
We may disclose PHI to law enforcement officials as required or permitted by law.
Workers’ Compensation
We may disclose PHI as necessary to comply with workers’ compensation laws.
Telehealth
If you receive services through telehealth, your PHI may be transmitted electronically through secure, HIPAA-compliant platforms. While we take reasonable steps to protect electronic information, no system can guarantee absolute security.
Disclosures You May Object To
Unless you object, we may disclose PHI in the following circumstances:
- We may share PHI with a family member, friend, or other person involved in your care or payment for your care, or to notify them of your location or general condition.
- We may disclose PHI to public or private agencies for disaster relief purposes.
To object to these disclosures, please contact our Privacy Officer using the information listed above.
Your Rights
You have the following rights regarding your PHI:
Right to Access
You have the right to inspect and obtain a copy of your PHI that is used to make decisions about your care. Requests must be made in writing. We may charge a reasonable fee for copies and will respond within 30 days, unless an extension is permitted by law.
Right to Amend
If you believe your PHI is incorrect or incomplete, you may request an amendment in writing, including the reason for your request. We will respond within 60 days. We may deny the request if the information is accurate and complete, was not created by us, or is not part of the record available for inspection.
Right to an Accounting of Disclosures
You may request a list of certain disclosures of your PHI made by us within the past six years. Requests must be made in writing. The first request within a 12-month period is free; additional requests may incur a reasonable fee. This does not include disclosures for treatment, payment, healthcare operations, or those you authorized.
Right to Request Restrictions
You may request restrictions on certain uses or disclosures of your PHI. While we are not required to agree to all requests, we will comply when required by law. If you pay for services in full out-of-pocket, you may request that we not disclose information about those services to your health plan, and we will comply as required by law.
Right to Confidential Communications
You may request that we communicate with you in a specific way or at a specific location. Requests must be made in writing to the Privacy Officer, and we will accommodate reasonable requests.
Right to a Paper Copy
You may request a paper copy of this Notice at any time.
Other Uses and Disclosures
We will obtain your written authorization before using or disclosing your PHI for purposes not described in this Notice, unless otherwise permitted or required by law. You may revoke your authorization in writing at any time. Revocation will not affect actions already taken in reliance on the authorization.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with Sunflower Clinic or with the U.S. Department of Health and Human Services. Filing a complaint will not affect your care or treatment. We will not retaliate against you for filing a complaint.