Privacy Practices Legal Agreement
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.
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The Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) is a federal program that requires that all medical records and other individually identifiable health information used or disclosed by us in any form, whether electronically, on paper, or orally, are kept properly confidential. “HIPAA” provides penalties for covered entities that misuse personal health information. As required by “HIPAA”, we have prepared this explanation of how we are required to maintain the privacy of your health information and how we may use and disclose your health information.
We may use and disclose the minimum necessary information from your medical records for only the following purposes: ï‚· Treatment means providing, coordinating, or managing health care and related services by one or more health care providers. We may consult with other mental health professionals to enhance your treatment. We will also disclose protected health information to other healthcare providers who may be treating you when we have the necessary permission from you to disclose your protected health information.
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Definitions
The Company means the Business Operational Staff, Consultants and Supervision Staff and 3rd Party Affiliated Members of Cuyahoga Valley Mindful Health & Wellness LLC (2021), including but not limited to Debt Collection Staff and Legal Council involved in the activities of Legal Assistance, Consultation and Incurred Material or Intellectual Property Damages against the Company.
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Payment means activities such as confirming coverage, obtaining authorizations, requesting reimbursement for services, billing or collection activities, and utilization review. An example of this would be sending a bill for your visit to your insurance company for payment.
Services Rendered means activities related to Consultation, Athletic or Life Coaching, or Medical Services and/or the providing of Intellectual Property and/or Company Materials with or without payment to the Company by any Client, Patient, Business Associate, or Community Member. This includes all consultation services by Body Members and or Elected Officials and Officers for the Company using Intellectual Property owned by the Company.
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Health Care Operations include the business aspects of running our practice, such as conducting quality clinical assessment and operational improvement activities, auditing functions, cost-management analysis, customer service and the hiring and contracting of accounting staff, legal staff and/or affiliated officers for quality control procedures and risk management activities. We may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate which provider you will be seeing. We may also call you by name in the waiting room when your provider is ready to see you. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
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Intellectual Property means any Materials or Data owned by Cuyahoga Valley Mindful Health & Wellness LLC (2021). The Company reserves rights to withdraw Intellectual Property from Business Associates, Partners, 3rd Party Agencies or Clients at any time through this Agreement.
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Business Associate means any 3rd Party Organization engaged in the processing of and/or receiving of Consultation or Medical Services within the State of Ohio. Acceptance of Materials Provided or Services Rendered, or Participation in the Gathering of and/or processing of Medical or Consultation Data is legal consent to the Privacy Practices Agreement in the State of Ohio. All parties reserve the right to waive services or Business Associate Agreements upon remittance of Debts/and or Obligations Owed, Release of Materials and Intellectual Property to the Company. ​
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Abuse, Neglect & Limits to Confidentiality
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Abuse, Neglect or Exploitation: We are mandated by Ohio Law to report abuse, neglect or exploitation to the Department of Social Services shared with us by you and/or a family member.
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Serious and Imminent Threat: We are required by Ohio Law as a licensed Medical Center and Consultation Service working with mental health, substance abuse, youth and families to take action to protect those who are in danger of imminent harm such as suicide or homicide. This may involve screening and/or admission to a psychiatric hospital, warning someone who is in danger of being murdered, and contacting the police in accordance with Tarasoff v. Regents of the University of California (1976), Ewing v. Goldstein (2004), Hedlund v. Superior Court (1983), Jablonski v. United States (1983), Thompson v. County of Alameda (1980), and Ohio General Law for Medical Center and Clinician Duty to Warn, Duty to Protect.
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Legal Proceedings, Debt Collection, Refund Policy and Releases Required by Law
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Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to a court order, in response to a subpoena, discovery request or other lawful process. We may disclosure protected health information in the course of Collections for Debts Owed and/or Obligations to the Company.
Other Releases Required by Law: This includes but is not limited to health oversight agencies, public health, workers’ compensation agencies, licensing boards, and prisons. Any other uses and disclosures will be made only with your written authorization. You may revoke such authorization in writing and we are required to honor and abide by that written request, except to the extent that we have already taken actions relying on your authorization. We may also create and distribute de-identified health information by removing all references to individually identifiable information. We will share your protected health information with third party “business associates” that perform various activities (e.g., billing, transcription services) for the practice. Clinicians under supervision (LPC) are required to release and review medical documentation with business associate clinical supervisors (LPCC-S) as is common practice in Ohio under the CSWMFT Board for case conceptualization and ethical treatment review purposes.
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If you are receiving services through an Employee Assistance Program (EAP) or Workers’ Compensation, your EAP or Workers’ Compensation agency may obtain the minimum necessary information without your express authorization. This includes but is not limited to Ohio Department of Job and Family Services, Workers' Compensation Bureau, Ohio Mandated Reporting Services, The LCSWMFT Board of Ohio and Emergency Services.
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Cuyahoga Valley Mindful Health & Wellness, LLC may provide Community Members, Partner Agencies and Organizations and Business Associates with Consultation Services through Body Members for Professional Consultation Services within the State of Ohio as a Licensed Medical Center and Professional Specialist Consultation Services Company in Athletic Coaching and Wellness Services. Cuyahoga Valley Mindful Health & Wellness LLC (2021) is Licensed as Professional Medical Center and Consultation Firm with Intellectual Property Rights Owned of All Body Members providing Consultation Services without Explicit Consent given otherwise. Body Members and Board Members represent Cuyahoga Valley Mindful Health & Wellness LLC (2021) with all Intellectual Property Owned by the Company and not the Individual unless explicitly consented with review of Cuyahoga Valley Mindful Health & Wellness (2021) Legal Counsel and Board Members. All Provided Services, Consultations and Materials Provided are Intellectual Property Rights of Cuyahoga Valley Mindful Health & Wellness (2021) LLC with Strict Intellectual Property Utilization and Consultation Guidance Rights at Above Consultation and Intellectual Property Release Rights. Future Use of Cuyahoga Valley Mindful Health & Wellness LLC (2021) Intellectual Property Utilization May Result in Legal Ramifications and Litigation without expressed given Consent and Payment for Services Rendered. Improper Intellectual Property Utilization will result in Debt Obligations Owed to Cuyahoga Valley Mindful Health & Wellness LLC (2021) and may result in Litigation and Intellectual Property Right Damages Incurred for Debts Owed to the Consultant and Business. All Materials Received, Utilized and/or Trademarked are considered as Service Rendered for Consultation Services with Cuyahoga Valley Mindful Health & Wellness LLC (2021) as Custodian of Professional Services and Specialist Provider & Consultant in the State of Ohio as Licensed Consultation and Specialist Firm of Intellectual Property and Consultation Services. Debts Owed may be sent to Collections for Lacking Payment for Professional Consultation for an Ohio Business in Athletic Coaching and Wellness Services as Consultation Services are Not a Medical Service and are a Professional Consultation Service under Law. Payment Plans may be produced upon consultation with our Legal Counsel and Accounting Services.
Full Refunds may be provided up to 4 weeks after purchasing of training plan Athletic Coaching Services. Sliding fee scales are available for low-income athletes upon proof of household income from the most recent tax-year. Refund Requests after 4 Weeks of Services Provided may result in Collections to Accounts Past Due outside of the Refund Request Period. Attempts to Collect a Debt may result in releases of non-health related data to 3rd Party Partners (Business Associates) in accordance with Cuyahoga Valley Mindful Health & Wellness LLC (2021) Privacy Practices, Intakes and Confidentiality Agreements. Full Refunds for Cash-Based Patients are available on a Case-By-Case Basis determined by Financial Need and Treatment Progress after review from Legal Council and our Privacy Officers. All Refunds will be provided and immediately processed upon demonstration of strong financial need with considerable barriers to treatment progress and/or rapport within 4 weeks of services originally rendered. Refunds may be provided in partial amount or at no amount after 4 weeks of services rendered for treatment and medical services. All refunds provided for Athletic Coaching Services, Consultation Services and/or Medical Services will result in full surrendering of all Intellectual Property and Materials of Cuyahoga Valley Mindful Health & Wellness LLC (2021) unless otherwise noted in specific contractual agreement. Collections may be pursued for Intellectual Property Damages and/or Theft against the Company and Materials in accordance with our Privacy Practices and Legal Agreement.
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Patient & Client Rights and Privacy Officers, Advocacy and Disability & Reasonable Accommodation Requests​
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You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to the Privacy Officers: Wendy Nathan, LPCC-S & CEO Eric Riesterer, LPC.
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The right to release your medical records when you give written consent. You may revoke this authorization, in writing, at any time. A revocation is not valid when we have already acted on it prior to your revocation.
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The right to request restrictions on certain uses and disclosures of protected health information, including those related to disclosures to family members, other relatives, close personal friends, or any other person identified by you. If we do agree to a restriction, we must abide by it unless you agree in writing to remove it.
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The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations. This may include receiving bills at an alternate address or phone calls at only a certain number.
The right to receive services within reasonable accommodation to meet disability needs and/or reasonable accommodation needs, including but not limited to changes in Disability Status, physical welfare and cognitive welfare. Reasonable accommodations include but are not limited to online telehealth appointments, alternative physical location for services rendered, and/or adjustments in regular scheduling or time to receive professional services.
The right to inspect and copy your protected health information. A staff member will be present if you review your record in person. A summary of your notes may be provided in lieu of the actual record. (Copying of records does require payment of a fee in the amount of $25.00 per series of records, in accordance with laws in the State of Ohio.)
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The right to amend your protected health information. Information will not be removed or deleted from your record. You may give a written statement to amend your medical record.
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The right to receive an accounting of disclosures of protected health information outside of treatment, payment, and healthcare operations or other releases permitted by law. We will provide this free of charge once per year if requested.
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The right to obtain a paper or electronic copy of this notice from us upon request.
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The right to receive any future policy changes secondary to changes in state and federal laws. We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. This notice is effective as of 7/18/2022 written by Legal Council Associates and we are required to abide by the terms of the Notice of Privacy Practices currently in effect.
We reserve the right to change the terms of our Notice of Privacy Practices (in accordance with State and Federal law) and to make the new notice provisions effective for all protected health information that we maintain. We will post and you may request a written copy of a revised Notice of Privacy Practices from this office. You have recourse if you feel that your privacy protections have been violated. You have the right to file a written complaint with our office, or with the Department of Health and Human Services, Ohio Department of Job and Family Services, Office of Civil Rights, the Legal Aid Society of Cleveland & Akron about violations of the provisions of this notice or the policies and procedures of our office. We will not retaliate against you for filing a complaint to any Ohio Agency or the LCSWMFT Board within the State of Ohio.
