850 E. 300 So. Bldg. 1
SLC, UT 84102
This Notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
NOTICE OF PRIVACY PRACTICES
This Notice explains how we may use and disclose your personal health information, the choices and rights you have about how your personal health information may be used and disclosed, and our obligation to protect the privacy of your personal health information.
Susan Wiet, MD, is a licensed physician in the practice of psychiatry. She is nationally boarded in Adult, Child/Adolescent Psychiatry and Addiction Medicine. Psychiatric services are offered for clients in an outpatient office setting.
Introduction. When you become a client at Sovegna, you provide us with information about your health. Each time you visit us, another record of your visit and what was done is made. Your health record is the information that we use to plan your care, provide treatment and receive payment for our services. This document may be released to governing boards, such as the Department of Professional Licensing (DOPL) if you have been referred for assessment. It is important for you to understand that your health record contains personal health information that is protected by federal and state laws.
Our Responsibilities. Sovegna is required to maintain the privacy of your personal health information and to provide you with a notice about our legal duties and privacy practices with respect to your personal health information. Sovegna is also required to accommodate reasonable requests that you make to communicate personal health information by alternative means or at alternative locations. Any time she will use or disclose your personal health information, she must follow the terms of this Notice. Dr. Wiet uses the confidential and HIPAA-compliant, cloud-based Electronic Medical Record (EMR), Valant, and electronic communication with pharmacies through Dr. First. (The EMR and e-prescribe is subject to change based on product performance and Dr. Wiet’s discretion; clients will be notified in advance if/when an EMR will change.)
How We Use and Disclose Your Protected Health Information.
Uses and Disclosures for Treatment, Payment and Health Care Operations. After making a good faith effort to provide you with this Notice, Sovegna may use your personal health information (PHI) to provide your treatment, to obtain payment for your treatment and for our internal health care operations. Sovegna may use and disclose your personal health information for such purposes in the following ways:
(1) For Treatment. Sovegna may use and disclose your PHI to plan, provide and coordinate your health care services. For example, we may share written and verbal communication with your primary care physician, therapist or health care provider.
(2) For Payment. Sovegna may use and disclose your PHI to obtain payment for health care services we have provided to you. For example, Sovegna may send your insurance company or managed care organization information they may require as a condition of payment, including a psychiatric diagnosis, symptom, and progress.
(3) For Health Care Operations. Sovegna may use or disclose your protected health information for our health care operations. For example, Sovegna may use or disclose your PHI to perform risk assessment and other administrative tasks to monitor the quality of care that we provide.
Uses and Disclosures with Authorization. For uses and disclosures of your PHI not involving treatment, payment or health care operations, Sovegna will receive your written authorization prior to using or disclosing any personal health information (unless we are required or permitted by law to use or disclose your information as set forth below). You have the right to revoke any authorization previously granted. If you have any questions about written authorization, contact Sovegna at 385-429-9808, who will provide you with the information you need to revoke your authorization.
Uses and Disclosures Without Authorization. Sovegna may use and disclose your personal health information (PHI) without obtaining your consent or authorization in the following situations:
(1) Business Associates. There are some services that we provide through contract with our business associates. In such situations Sovegna may disclose your PHI to our business associates so they can perform the job we asked them to do. Sovegna requires all business associates to appropriately safeguard your information in accordance with applicable law.
(2) Notification of Family or Close Friends. Sovegna may use or disclose your PHI to notify a family member, personal representative or another person responsible for your care, provided you have the opportunity to agree or object to the disclosure. If you are unable to agree or object, we may disclose this information as necessary if we determine that it is in your best interest based upon our professional judgment. In all cases, we only disclose the health information relevant to that person’s involvement with your health care.
(3) Required by Law. Sovegna may use or disclose your PHI to the extent that we are required by law to do so. The use or disclosure will be made in full compliance with the application law governing disclosure. Therapy notes require additional authorization and notification.
(4) Public Health Activities. Sovegna may disclose your PHI for public health activities to a public health authority authorized by law to collect or receive information for the purpose of controlling disease, injury or disability. We may also disclose your health information to a public authority authorized to receive report of child abuse or neglect or to report information about products or services under the jurisdiction of the United States Food and Drug Administration. Additionally, Dr. Wiet may disclose your health information to a person who may have been exposed to a communicable disease or otherwise be at risk of contracting or spreading a disease and to your employer for certain work-related illnesses or injuries.
(5) Health Oversight Activities. Sovegna may make disclosure of your PHI to a health oversight agency charged with overseeing the health care industry. Disclosures will be made only for activities authorized by law.
(6) Judicial and Administrative Proceedings. Sovegna may disclose your PHI in the course of any judicial or administrative hearing in response to an order of the court or administrative tribunal, or in response to a subpoena, discover request or other lawful process where Sovegna receives satisfactory assurance that appropriate precautions have been taken. In all cases, Sovegna will take reasonable steps to protect the confidentiality of your health information.
(7) Law Enforcement. Sovegna may disclose your PHI for a law enforcement purpose to law enforcement officials in compliance with and as limited by applicable law.
(8) Marketing. For marketing activities, Sovegna will obtain your written authorization prior to sending any information to you, unless Sovegna is not required by law to do so.
(9) Research. Sovegna may use or disclose your PHI without your authorization for research purposes when such research has been approved by an institutional review board that has reviewed the research to insure the privacy of your PHI, or as otherwise allowed by law.
(10) Victims of Abuse, Neglect, or Domestic Violence. Sovegna may disclose PHI about an individual whom we reasonably believe to be a victim of abuse, neglect or domestic violence to a government authority, including a social service or protective service agency authorized by law to receive reports of child abuse, neglect or domestic violence. Any such disclosures will be made in accordance with and limited to the requirements of the law.
(11) Limited Government Functions. Sovegna may disclose your PHI to certain government agencies charged with special government functions, as limited by applicable law. For example, Sovegna may disclose health information to authorized federal officials for the conduct of national security activities required by law.
(12) Organ Procurement. Sovegna allowed by law we may disclose PHI to organ procurement organizations for organ, eye or tissue donation.
(13) Health and Safety. Sovegna may disclose your PHI to prevent or lessen a serious threat to a person or the public’s health and safety. In all cases, disclosure will only be made in accordance with applicable law and standards of ethical conduct.
(14) Worker’s Compensation (WC) and Department of Professional Licensing (DOPL). Sovegna may disclose your PHI in accordance with WC laws and/or DOPL oversight policies.
You Have the Right to the Following:
• Right to Receive a Copy of this Notice. Upon request you have the right to receive a paper copy of this Notice.
• Right to Receive Further Information. You have the right to contact Sovegna 850 E. 300 So. #1 SLC, UT 84102, if you want additional information about our privacy practices, your privacy rights, or disagree about a decision we make about your personal health information, or if you believe that your privacy rights have been violated. Sovenga will provide you with the information you need to file a complaint.
• Right to Inspect and Copy Your Health Information. Upon written request, you have the right to access and obtain a copy of your health information maintained by us. Please contact Sovegna for information you need to access and copy your protected health information.
• Right to Amend Your Health Information. You have the right to request in writing that we amend health information maintained in your health record. Sovegna will not comply with your request in the event that it is determined the information that would be amended is false, inaccurate, or misleading. Please contact Dr. Wiet for information you need to request an amendment of your personal health information.
• Right to Request Additional Restrictions on Uses and Disclosures of Your Health Information. You have the right to request in writing that Sovegna place additional restriction on how your information is disclosed about your personal health information. While Sovegna will consider any request for additional restrictions, Sovegna is not required to agree to your request. Please contact Sovegna for information you need to request additional restrictions on how Sovegna may use and disclose your personal health information.
• Right to Request an Accounting of Disclosures. You have the right to request in writing an accounting of certain disclosures made by Sovegna of your personal health information. For each disclosure, the accounting will include the date the information was disclosed, to whom, the address of the person or entity that received the disclosure (if known), and a brief statement of the reason for the disclosure. Please contact Sovegna for information you need to request an accounting of disclosures.
• Right to Request Confidentiality in Certain Communications. You have the right to request to receive your health information by alternative means of communication or at alternative locations. Sovegna will accommodate any such reasonable written request made on your behalf. Please contact Sovegna for information you need to request confidentiality in certain communications.
• Right to File a Complaint. If you believe your privacy rights have been violated, in addition to filing a complaint with us, you have the right to file a written complaint with the Office of Civil Rights of the United States Department of Health and Human Services. Upon request, Sovegna will provide you with the information needed to file your complaint. Under no circumstances will Sovegna retaliate against you for filing a complaint with us or the Office of Civil Rights.
Privacy Officer. To contact our Privacy Officer, please address all requests to Susie Wiet MD, the Privacy Officer, at 850 E. 300 So. Bldg. #1, SLC, UT 84102.
Changes to Notice: Sovegna reserves the right to change our privacy practices and to alter this Notice according to those changes. In the event that our Notice changes, we will mail you a copy of our revised notice to the address you have supplied us.
Effective Date of the Notice: December 2015.