HIPAA Privacy Notice

By proceeding forward after reading this HIPAA Privacy Authorization, you are agreeing to the terms and conditions listed below. 

Authorization for Use or Disclosure of Protected Health Information

(Required by the Health Insurance Portability and Accountability Act, 45 C.F.R. Parts 160 and 164)

The Health Insurance Portability and Accountability Act (HIPAA) establishes client rights and protections associated with the use of protected health information. HIPAA provides client protections related to the electronic transmission of data (“the transaction rules”), the keeping and use of client records (“privacy rules”), and storage and access to health care records (“the security rules”). HIPAA applies to all health care providers. Providers and health care agencies are required to provide clients a notification of their privacy rights as it relates to their health care records.

This client Notification of Privacy Rights informs you of your rights. Please carefully read this client Notification. It is important that you know and understand the client protections HIPAA affords you as a client.

In functional medicine fertility coaching, confidentiality and privacy are central to the success of the professional relationship; therefore, I will do all we can do to protect the privacy of your health records. If you have questions regarding matters discussed in this client Notification, please do not hesitate to ask.

I. Preamble

Records are kept documenting your care as required by law, professional standards, and other review procedures. HIPAA clearly defines what kind of information is to be included in your “designated medical record” or “case record” which is not accessible to insurance companies and other third-party reviewers. HIPAA provides privacy protections about your personal health information, which is called “protected health information (PHI)” which could personally identify you. PHI consists of three (3) components: treatment, payment, and health care operations.

Treatment refers to activities/sessions provided by Simplina providers, coordinated or managed as part functional medicine fertility coaching service or other services related to your health. Examples include personal nutritional counseling sessions with a provider. Utilizing the app is a way to track progress of health coaching goals discussed in the session. The app is not a replacement for contact with a healthcare provider. 

Payment is when Simplina™, obtains reimbursement for your nutrition fertility coaching or other services related to your health.

Health care operations are activities related to services such as quality assurance. The use of your protected health information refers to activities Simplina conducts for scheduling appointments, keeping records, and other tasks related to your care. Disclosures refer to activities you authorize such as the sending of your protected health information to other parties (i.e., your insurance company).

II. Uses and Disclosures of Protected Health Information Requiring Authorization

If you request Simplina™ to send any of your protected health information of any sort to anyone outside of our fertility health coaching program, you sign our user agreement upon starting fertility coaching that information can be shared and then specify to us who you would like your healthcare information shared with to our administrative team at hello@simplina.com.  You can always request a copy of our authorization form at hello@simplina.com. 

III. Uses and Disclosures Not Requiring Consent or Authorization

By law, protected health information may be released without your consent or authorization under the following conditions:

  • Suspected or known child abuse or neglect

  • Suspected or known sexual abuse of a child

  • Adult and Domestic abuse

  • Judicial or administrative proceedings (i.e. you are ordered here by the court)

  • Serious threat to health or safety (i.e. “Duty to Warn” and Threat to National Security)

IV. Client’s Rights and Our Duties

You have a right to the following:

  • The right to request restrictions on certain uses and disclosures of your protected health information which I may or may not agree to but if I do, such restrictions shall apply unless our agreement is changed in writing

  • The right to receive confidential communications by alternative means and at alternative locations. For example, you may not want forms mailed to your home address so I will send them to another location of your choosing.

  • The right to inspect and copy your protected health information in the designated record and any billing records for as long as protected health information is maintained in the record.

  • The right to insert an amendment in your protected health information, although the healthcare provider may deny an improper request and/or respond to any amendment(s) you make to your record of care.

  • The right to an accounting of non-authorized disclosures of your protected health information.

  • The right to a paper copy of notices/information from Simplina™, even if you have previously requested electronic transmission of notices/information.

  • The right to revoke your authorization of your protected health information except to the extent that action has already been taken.

For more information on how to exercise each of these aforementioned rights, please do not hesitate to ask for further assistance on these matters.  Our Simplina team is here to help you at hello@simplina.com. 

Simplina™ is required by law to maintain the privacy of your protected health information and to provide you with a notice of your Privacy Rights and our duties regarding your PHI. Simplina™ reserves the right to change its privacy policies and practices as needed with these current designated practices being applicable unless you receive a revision of these policies when you come for future appointment(s). Our duties in these matters include maintaining the privacy of your protected health information, to provide you with a notice of your rights and our privacy practices with respect to your PHI, and to abide by the terms of the notice unless it is changed and you are notified.

V. Complaints

The right to have oral or written instructions for filing a grievance. The right to file a grievance is not time limited. If you need assistance in filing a grievance or want further information, please contact:

U.S. Department of Health and Human Services

200 Independence Avenue, S.W.

Room 509F HHH Bldg.

Washington, D.C. 20201

If you have any questions you may contact our office by sending an email to hello@simplina.com. We are here to help.