Notice of Privacy Practices

This notice describes how medical information about you may be disclosed and how you can get access to this information. Please review carefully. 

The terms of this Notice of Privacy Practices apply to Inspire Therapeutic Services, LLC operating as a behavioral health care organization, contractors, employees, and other licensed professionals seeing and treating clients. The members of this behavioral health care organization will share protected health information of our clients as necessary to carry out treatment, payment, and health care operations as permitted by law. 

We are required by law to maintain the privacy of our clients’ protected health information and to provide clients with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all protected health information maintained by us. You may receive a copy of any revised notices from the location in which you have received services, or a copy may be obtained by mailing a request to the following address: Inspire Therapeutic Services, LLC. P O BOX 584 North Aurora, IL 60542.

Uses and Disclosures of Your Protected Health Information

Your Authorization: Except as outlined below, we will not use or disclose your protected health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization. There are certain uses and disclosures of your protected health information for which we will always obtain a prior authorization, and these include: 

· Psychotherapy notes unless otherwise permitted or required by law. 

Uses and Disclosures for Treatment: With your approval, we will use and disclose your protected health information as necessary to provide, coordinate, or manage your treatment. For instance, therapists, doctors, and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, test, etc. We may also release your protected health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing health or mental health treatment to you. 

Uses and Disclosures for Payment: We will use and disclose your protected health information as necessary for the payment of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your diagnosis and treatment to your insurance company to arrange a payment for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for payment of your bill. 

Family and Friends Involved in Your Care: With your approval, from time to time we may disclose your protected health information to designated family, friends, and others who are involved in your care, or are involved in payment for your care, in order to facilitate that person’s involvement in caring for you or in paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation, and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval. We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you. 

Appointments and Services: We may contact you to provide appointment reminders. You have the right to request, and we will accommodate reasonable requests, to receive communications regarding your protected health information from us by alternative means or at alternative locations. For instance, if you would prefer that appointment reminders not be left on voice mail, we will accommodate all reasonable requests. You may request such confidential communication in writing by sending your request to Inspire Therapeutic Services, LLC. PO BOX 584 North Aurora, IL 60542. 

Confidentiality of Alcohol and Drug Abuse Client Records: The confidentiality of alcohol and drug abuse client records maintained by this facility is protected by federal law and regulations. Generally, the facility may not say to a person outside the program that you attend a drug or alcohol program or disclose any information identifying you as an alcohol or drug abuser unless: (1) you consent in writing; (2) the disclosure is allowed by a court order; or (3) the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation. Federal law and regulations do not protect information about a crime committed by you either at our facility or against any person who works for the facility or about any threat to commit such a crime. Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities. 

Other Uses and Disclosures: We are permitted or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization. We may release your protected health information: 

• For any purposes required by law; 
• As required by law if we suspect child abuse or neglect; we may also release your protected health information as required by law if we believe you to be a  victim of abuse, neglect, or domestic violence. The duty to report abuse,  including abuse of children, elderly persons and adults with developmental disabilities, supersedes (by law) any requirements of confidentiality. In general, professionals and persons involved in the human services system  are required to report abuse if they have reason to believe there is a wound, injury, disability, neglect or emotional condition which reasonably indicates that abuse has occurred. 
• When an individual’s condition represents an immediate threat to the physical  safety of self or others, information may be disclosed for the purpose of  preventing danger/harm. 
• When an individual represents a substantial and immediate risk of serious physical impairment  or injury to himself as manifested by evidence that he is unable to  provide for and is not providing for his basic physical needs because of  mental illness, information may be disclosed for the purpose of preventing danger/harm. 
• Information in your treatment file may be subject to an order by the court. At that time, Inspire Therapeutic Services, LLC would obey an order from a court to provide your record. 
• A parent,  including a non-custodial parent or legal guardian, has the right to review information in the file pertaining to the child, the child’s  treatment and disclosures made by the child, unless specified otherwise in a court order. 
• A legal guardian of an adult has the right to review information in a file pertaining to that adult. 
• To your employer when we have provided healthcare to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer; 
• If required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings; 
• If required to do so by subpoena or discovery request; in most cases, you will have notice of such release; 
• To law  enforcement officials as required by law to report wounds, injuries, and crimes; 
• To coroners and/or funeral directors consistent with law; 
• If, in limited instances, we suspect a serious threat to health and safety; 
• As required by armed forces services if you are a member of the military; we may also release your protected health information if necessary, for national security or intelligence activities; and 
• To workers’ compensation agencies if necessary, for your workers’ compensation benefit determination. 

Rights That You Have 

Access to Your Protected Health Information: You have the right to copy and/or inspect much of the protected health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. We will charge you $25.00 if you request a copy of the information. We will also charge for the postage if you request a mailed copy and will charge for preparing a summary of the requested information if you request such summary. You can obtain a request form from the program where you received services. 

You have the right to obtain an electronic copy of your health information that exists in an electronic format, and you may direct that the copy be transmitted directly to an entity or person designated by you, provided that any such designation is clear, conspicuous, and specific with complete name and mailing address or other identifying information. We will charge you a $25.00 fee for preparing your copy of the electronic health information.

Amendments to Your Protected Health Information: You have the right to request in writing that protected health information we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. In order to be considered by us, all amendment requests must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If any amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from the program where you have received services. 

Breach Notification: In the unlikely event that there is a breach or unauthorized release of your protected health information, you will receive notice and information on steps you may take to protect yourself from harm. 

Complaints: If you believe your privacy rights have been violated, you can file a complaint, in writing with our office, or by mail to: Inspire Therapeutic Services, LLC. PO BOX 584 North Aurora, IL 60542. You may also file a complaint, in writing with the Secretary of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue SW, Washington DC, 20201.There will be no retaliation for filing a complaint. 

Acknowledgment of Receipt of Notice: You will be asked to sign an acknowledgment form that you received the Notice of Privacy Practices. 

For Further Information: If you have questions or need further assistance regarding this Notice, you may contact our office, or write to Inspire Therapeutic Services, LLC. PO BOX 584 North Aurora, IL 60542. As a client, you have the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means. For more information on HIPAA privacy requirements, HIPAA electronic transactions and code sets regulations and the proposed HIPAA security rules, please visit HHS.gov. 

Effective Date: This Notice of Privacy Practices is effective 07/27/2021