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HIPAA NOTICE OF PRIVACY PRACTICES​

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

This Notice describes how Synapse Health, LLC (the “we,” “us,” “our,” or “Synapse”) may use and/or disclose your protected health information (“PHI”), and the rights you have with respect to your PHI. “PHI” includes any information that (i) may identify you, (ii) is created, received, maintained, or transmitted”), and (iii) relates to your past, present, or future physical or mental health or condition, the provision of health care to you, or the past, present, or future payment for the provision of health care to you. We are committed to protecting the privacy of your PHI. This Notice applies to all PHI created, received, maintained, or transmitted by Synapse. All employees and business associates of Synapse who may have access to your PHI are permitted to use and disclose your PHI only as set forth in this Notice.

YOUR RIGHTS

You have the right to:

  • Receive a Copy of Your Medical Record. You have the right to see or obtain an electronic or paper copy of your medical record and other health information we have about you. You must submit your request in writing to Synapse’s Privacy Officer, as identified on the last page of this We will provide a copy or a summary of your medical record, usually within 30 days of your request. We may charge a reasonable, cost-based fee for providing you a copy of your medical record.
  • Ask Us to Amend Your Medical Record. If you feel that information in your medical record is incorrect or incomplete, you may ask us to amend the To request an amendment, your request must be made in writing and submitted to Synapse’s Privacy Officer, as identified on the last page of this Notice. We will respond to your request within 60 days. In certain circumstances, we may deny your request for an amendment. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you choose not to file a written statement of disagreement, you have the right to ask that your request and our denial be attached to all future disclosures of your PHI.
  • Receive an Accounting of Disclosures. You have the right to ask for an accounting (list) of the times we have shared your health information, who we have shared it with, and why. The list will include all disclosures except for those pertaining to treatment, payment, and healthcare operations, and certain other disclosures (such as any disclosures that were made at your request). To request an accounting of disclosures, you must submit your request in writing to Synapse’s Privacy Officer, as identified on the last page of this Your request must include a time period for which you are requesting an accounting of disclosures, which may not be longer than six years prior to the date of your request. We will respond within 60 days of receiving your request. We will provide you with one accounting per year at no cost, but may charge a reasonable, cost-based fee for any additional requests for an accounting.
  • Request Restrictions on How We Use Your PHI. You may ask us not to use or share certain PHI for treatment, payment, or healthcare operations purposes, and may request to limit the information we share with an individual who is involved in your care, like a family member or We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or unless the information is required to be disclosed by law. If you pay for a healthcare item or service out-of-pocket in full, you may ask us not to share information regarding such item or service with your health insurance company. We will comply with your request unless the information is required to be disclosed by applicable law. To request a restriction, you must make your request in writing to our Privacy Officer, as identified on the last page of this Notice.
  • Request Confidential Communications. You may ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. We will not ask you the reason for your request and will accommodate all reasonable To request confidential communications, you must make your request in writing to our Privacy Officer, as identified on the last page of this Notice. Your request must specify how or where you wish to be contacted.
  • Receive a Copy of this Notice. You may ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. We will promptly provide you with a paper copy. To obtain a paper copy of this Notice, contact our Privacy Officer, as identified on the last page of this
  • Choose Someone to Act for You. If you have designated a healthcare power of attorney or if someone is your legal guardian or personal representative, that person may exercise your rights and make choices about your health information. We will confirm that the person has authority to act on your behalf before we take any action.
  • File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with Synapse or the Department of Health and Human Services, Office for Civil Rights (“OCR”). To file a complaint with us, please contact our Privacy Officer as identified on the last page of this Notice. Forms and instructions for filing a complaint with OCR may be found at the following web address: https://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html. You will not be retaliated against or penalized by us for filing a

YOUR CHOICES

For certain PHI, you may tell us your choices regarding what we share. In the following situations, you have the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a hospital directory

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 your information when needed to lessen a serious and imminent threat to health or safety.

We never share your information for the following purposes unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

OUR USES AND DISCLOSURES OF PHI

Treatment, Payment, and Healthcare Operations

We typically use or share your information for the following purposes, as permitted by the Health Insurance Portability and Accountability Act (“HIPAA”):

Treatment. We may use and disclose your PHI to provide, coordinate, or manage your treatment and related services. We may disclose PHI about you to doctors, nurses, technicians, or other personnel who are involved in taking care of you.

Payment. We may use and disclose your PHI for the treatment and services you receive to bill, and receive payment from, an insurance company or other third party. For example, we may need to disclose information about your treatment to your health plan so it can pay us or reimburse you for the cost of that treatment.

Health Care Operations. We may use and disclose your PHI for our own healthcare operations purposes. For example, we may use PHI to review our treatment and services. We may also disclose PHI to another healthcare provider for certain health care operations of that entity, if the entity either has or had a treatment relationship with you, and the PHI pertains to such relationship.

Disclosures to Business Associates. We may disclose your PHI to third party “business associates” that perform various functions on behalf of Synapse and that have agreed to provide the same protections for your PHI.

Other Permitted Uses and Disclosures

The following are additional purposes for which we may use and disclose your PHI, as permitted by HIPAA:

As Required by Law. We may share information about you if state or federal law requires it, including with the Department of Health and Human Services to show we are complying with federal privacy laws like HIPAA.

Organ and Tissue Donation. If you are an organ donor, we may disclose PHI about you to organizations that handle organ or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Workers’ Compensation, Law Enforcement, and Other Government Requests. We may use or share your PHI: (i) for workers’ compensation claims; (ii) for law enforcement purposes or with a law enforcement official; (iii) with health oversight agencies for activities authorized by law; (iv) for special government functions such as military, national security, and presidential protective services.

Public Health and Safety Issues. We may disclose PHI about you for certain situations, such as: (i) preventing disease; (ii) helping with product recalls; (iii) reporting adverse reactions to medications; (iv) reporting suspected abuse, neglect, or domestic violence; and (v) preventing or reducing a serious threat to anyone’s health or safety.

Research. We may use or share your PHI for health research.

Medical Examiners and Funeral Directors. We may share PHI with a coroner, medical examiner, or funeral director if you die.

Lawsuits and Legal Actions. We may share your PHI in response to a court or administrative order, or in response to a subpoena.

OUR RESPONSIBILITIES

We are required by law to maintain the privacy and security of your PHI. We are required to provide you notice of our legal duties and privacy practices with respect to PHI. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your PHI. We must fulfill the duties and follow the privacy practices described in this Notice. We must provide you a copy of this Notice upon request.

We will not use or share your PHI other than as described in this Notice unless you give us permission in writing. Even if you give us that permission, you may change your mind at any time by letting us know in writing.

CHANGES TO THIS NOTICE

We may change the terms of this Notice at any time, and the changes will apply to all information we have about you. The revised Notice will be available upon request, in our office, and on our website.

PRIVACY OFFICER

Synapse Health’s Privacy Officer for all issues regarding your rights under HIPAA is Caroline Jackson, who may be contacted by phone at (888) 336-9363, by email at compliance@synapsehealth.com, and by writing to the following address:

Synapse Health, Inc.
Attn: Privacy Officer
3755 Chase Avenue
Skokie, IL 60076