Notice of Privacy Practices

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.

Effective Date: September 1, 2023

Purpose

Lucid Lane Providers P.C.  (“Lucid Lane”) is required by law to maintain the privacy of your protected health information (“PHI”) in accordance with federal and state law. This Notice of Privacy Practices (“Notice”) outlines our legal duties and privacy practices with respect to PHI. We are required by law to provide you with a copy of this Notice and to notify you following a breach of your unsecured PHI.

This Notice will guide our uses and disclosures of PHI, and we are required to abide by the terms of the Notice that is currently in effect. We reserve the right to make changes to this Notice as permitted by law. We reserve the right to make the new Notice provisions effective for all PHI we currently maintain, as well as any PHI we receive in the future. If we make material or important changes to our privacy practices, we will promptly revise our Notice. Each version of the Notice will have an effective date listed on the first page. If we change this Notice, you can access the revised Notice on our website  https://www.lucidlane.com/noticeofprivacypolicy by contacting the Privacy Official as indicated in the “Contact Information” section of this Notice. 

HIPAA and Part 2 

Lucid Lane is considered to be a “covered entity” that is regulated by the Health Insurance Portability and Accountability Act (“HIPAA”).  Additionally, in some limited instances, the PHI we access and maintain may be subject to other health information privacy laws that may be more stringent than HIPAA. For example, the medication assisted treatment services that are provided by Lucid Lane (“Covered Services”) are regulated by and subject to 42 Part 2 (“Part 2”) in addition to the HIPAA requirements. Part 2 significantly restricts how we may use and disclose your PHI if you are receiving Covered Services. 

We follow the Part 2 requirements for those  clients who receive Covered Services from us. If you receive such Covered Services from us, we may ask for your written consent to use and disclose your PHI for  certain additional uses and disclosures, even when your written consent would not otherwise be required by HIPAA. 

Lucid Lane values its patients’ privacy and its obligations to comply with HIPAA, Part 2 and other health information privacy laws.

Uses and disclosures of your PHI that do not require your consent

For those patients who are receiving Covered Services, Lucid Lane may use or disclose PHI without your prior written consent in the following circumstances:

Medical Emergencies: Lucid Lane may disclose PHI to the extent necessary to meet a bona fide medical emergency where your prior informed consent cannot be obtained. Similarly, Lucid Lane may disclose PHI to Food and Drug Administration (“FDA”) personnel who are seeking to notify patients or their physicians of potential dangers associated with a product subject to the FDA’s oversight. 

Research: Lucid Lane may disclose PHI for the purpose of conducting scientific research provided that the requisite Part 2 elements are met (i.e. that the information will be protected as required by law and an authorized representative determines that the recipient of the PHI meets the elements required by Part 2 related to the use and disclosure of PHI for research purposes). 

Audits and Evaluation: Lucid Lane may disclose PHI for audit or evaluation purposes. This may include sharing PHI with an individual or entity for an audit or evaluation on behalf of a federal, state, or local government agency or another entity that oversees Lucid Lane’s functions. 

Court Orders: Lucid Lane may disclose PHI in response to a court order. However, both HIPAA and Part 2 include requirements designed to protect your PHI during the judicial or other legal process.

Immediate Threats: Lucid Lane may disclose certain limited PHI to report an immediate threat to the health or safety of an individual due to a crime on Lucid Lane premises or against Lucid Lane personnel.   

In addition to the above, certain information is not covered by Part 2 and is therefore subject to additional use and disclosure without your consent, as described in the next section below.

USES AND DISCLOSURES OF YOUR PHI THAT DO NOT REQUIRE YOUR CONSENT FOR NON-PART 2 RECORDS

For those patients who are not receiving Covered Services from us, and thus whose records are not subject to Part 2 as described above, Lucid Lane may use and disclose your PHI without your prior written consent in the following circumstances: 

Treatment. We may use and disclose your PHI to provide medical treatment and services. For example, the PHI may be disclosed to therapists or other Lucid Lane team members who are involved in your care to coordinate or manage your health care services or to facilitate consultations or referrals as part of the treatment. We may use and disclose your health information to remind you of upcoming appointments. Unless you direct us otherwise, we may leave messages on your telephone answering machine or voicemail identifying Lucid Lane and asking for you to return our call.

Payment. We may use and disclose your PHI to obtain payment for the services we provide to you. For example, we may disclose your PHI to seek payment from your insurance company or from another third party. We may also inform your insurance company about a treatment you are going to receive so that we may obtain prior approval for the treatment or in order to determine whether your insurance company will cover the cost of the treatment.

Health Care Operations. We may use and disclose your PHI to conduct certain of our business activities. We call these our “health care operations.” These uses and disclosures help us run our business and make sure our patients receive quality care. For example, we may use your PHI for quality assessment activities, necessary credentialing, and for other essential activities. We may also disclose your PHI to third party “business associates” or “qualified services organizations” that perform various services on our behalf such as billing and client data collection. In these cases, as required by law, we will enter into a written agreement with the business associates or qualified services organizations to ensure they protect the privacy of the PHI.

Uses and disclosures of your PHI that may require your consent

General disclosures. Lucid Lane may share PHI with any person or categories of persons identified or generally designated by you in a written consent form for the purposes identified in the consent form, provided that additional requirements must be satisfied for Lucid Lane to share PHI with a central registry or with the criminal justice system.

Family Members and Friends for Care and Payment and Notification. We may disclose certain PHI to your family, friends, and anyone else whom you identify as involved in your health care or who helps pay for your care. In general, the PHI we disclose would be limited to the PHI that is relevant to that person’s involvement in the care or payment for your care. We may use or disclose your PHI to notify, or assist in notifying, a family member, personal representative, or any other person responsible for your care regarding your location, general condition, or death. 

Disaster Relief Purposes. We may also use or disclose the PHI to disaster-relief organizations so that your family or other persons responsible for your care can be notified about your condition, status, and location.

Purposes Required by Law. We may disclose your PHI when we are required by law to do so.

Public Health Reporting. We may disclose your PHI to public health agencies as authorized by law. For example, we may report certain communicable diseases to the state’s public health department.

Creation of De-Identified PHI. We may use your PHI to create de- identified PHI or limited data sets. We will remove identifiers as required by law for these purposes.

Reporting Victims of Abuse or Neglect. We may disclose PHI to the appropriate government authority if we believe you/your family member has been the victim of abuse, neglect, or domestic violence. We only make this disclosure if you agree or when we are required or authorized by law to make the disclosure.

Health Care Oversight. We may disclose the PHI to authorities and agencies for oversight activities allowed by law, including audits, investigations, inspections, licensure and disciplinary actions, or civil, administrative, and criminal proceedings, as necessary for oversight of the health care system, government programs, and civil rights laws.

Legal Proceedings. We may disclose your PHI in the course of certain administrative or judicial proceedings. For example, we may disclose your PHI in response to a subpoena or court order.

Law Enforcement. We may disclose your PHI to a law enforcement official for certain specific purposes, such as reporting certain types of injuries.

Research. Under certain circumstances, we may disclose your PHI to researchers who are conducting a specific research project. For certain research activities, an Institutional Review Board (IRB) or Privacy Board may approve uses and disclosures of your PHI without your authorization.

Purposes Related to Organ Donation and Death. For example, we may share your PHI with organ procurement organizations or with medical examiners or funeral directors.

To Avert a Serious Threat to Health or Safety. If there is a serious threat to your health and safety or the health and safety of the public or another person, we may use and disclose your PHI in a very limited manner to someone able to help lessen the threat.

Specialized Government Functions. In certain circumstances, HIPAA authorizes us to use or disclose your PHI to authorized federal officials for the conduct of national security activities and other specialized government functions.

Please be aware that state and other federal laws may impose additional requirements related to how we use and disclose your PHI. These laws may be more restrictive than HIPAA. If there are specific more restrictive requirements, even for some of the purposes listed above, we may require your written authorization before we use or disclose your PHI. For example, if you are receiving Covered Services, we may be required to obtain your written consent prior to using or disclosing your PHI in the instances described above in “Uses and Disclosures of Your PHI That Do Not Require Consent for Non-Part 2 Records.”  In addition, we may be required by law to obtain your written permission to use and/or disclose your PHI related to mental illness, alcohol or drug abuse treatment records, HIV, STD, or other communicable disease related information, or genetic test results.

Other uses and disclosures

Disclosure of your PHI or its use for certain purposes other than those listed above requires your specific written consent or authorization. This includes most sharing of your psychotherapy notes, using your PHI for marketing purposes and engaging in the sale of your PHI.

We may use your PHI for fundraising purposes, but you can ask us not to contact you again.

Revoking consents or authorizations

If you change your mind after authorizing a use or disclosure of your PHI, you may withdraw your permission by revoking the consent or authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of your PHI that occurred before you notified us of your decision, or any actions that we have taken based upon your authorization. To revoke a consent or authorization, you must contact the Privacy Official in writing as indicated in the “Contact Information” section of this Notice.

Your rights regarding your protected PHI

This section describes your rights regarding the PHI we maintain about you. All requests or communications to us to exercise your rights discussed below must be submitted in writing to the Privacy Official as indicated in the “Contact Information” section of this Notice. The Privacy Official may ask you to complete a specific form before processing your request.

Right to Request Restrictions. You have the right to request restrictions on how your PHI is used or disclosed for treatment, payment, or health care operations activities. However, we are not required to agree to your requested restriction, unless that restriction is regarding disclosure of PHI to your health insurance company and: (1) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and (2) the PHI pertains solely to a healthcare item or service for which you or another person (other than your health insurance company) paid for in full. If we agree to your requested restriction, we will comply with your request unless the information is needed to provide you emergency treatment.

Right to Request Confidential Communications. You have the right to request that we communicate your PHI to you in a certain manner or at a certain location. For example, you may wish to receive information about your health status through a written letter sent to a private address. We will grant reasonable requests to the best of our ability.

Right to Inspect and Copy. You have the right to inspect and receive a copy of your PHI. We may charge you a fee as authorized by law to meet your request. You can ask us for more information about how to make this type of request. 

Right to Amend. You have a right to request that we amend or correct your PHI that you believe is incorrect or incomplete. For example, if your date of birth is incorrect, you may request that the information be corrected. To request a correction or amendment to the PHI, you must make your request in writing and provide a reason for your request. If we deny your request, we will provide you with a written explanation of the denial.

Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures we make of your PHI. Please note that certain disclosures need not be included in the accounting we provide to you. Your request must state a time period which may not go back further than six years. You will not be charged for this accounting, unless you request more than one accounting per year, in which case we may charge you a reasonable cost-based fee for providing the additional accounting(s). We will notify you of the costs involved and give you an opportunity to withdraw or modify your request before any costs have been incurred.

Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice at any time, even if you previously agreed to receive this Notice electronically. A paper copy of this Notice can be obtained by contacting our Privacy Official as indicated in the “Contact Information” section of this Notice or through https://www.lucidlane.com/noticeofprivacypolicy website. 

Complaints

You have the right to file a complaint if you believe your privacy rights have been violated. All complaints must be submitted in writing.

If you would like to file a complaint about our privacy practices, you can do so by contacting the Privacy Official as indicated in the “Contact Information” section of this Notice. You also have the right to complain to the Secretary of the United States Department of Health and Human Services:

DHHS, Office of Civil Rights 
Centralized Case Management Operations
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F HHH Bldg.
Washington, D.C. 20201
1-800-368-1019
TDD: 1-800-537-7697

A violation of Part 2 by Lucid Lane is a crime, and suspected violations may be reported to the United States Attorney for the judicial district in which the violation occurs, as well as to the Substance Abuse and Mental Health Services Administration (SAMHSA) office responsible for opioid treatment program oversight.

You can find the contact information for your local United States Attorney by accessing https://www.justice.gov/usao/us-attorneys-listing. The contact information for SAMHSA is as follows:

Substance Abuse and Mental Health Services Administration

5600 Fishers Lane
Rockville, MD 20857
TEL: 877-726-4727
TTY: 800-487-4889

You will not be penalized or otherwise retaliated against for filing a complaint.

Contact information 

If you have questions or concerns about your privacy rights, or the information contained in this Notice, please contact the Privacy Official as indicated below. Covered Entity works Lucid Lane, Inc. with respect to privacy compliance matters.

By Mail:

Lucid Lane
Attention: Privacy Official
PO BOX 87703
Carol Stream, IL 60188

By Telephone: 
(630) 449.4631 

By Email:
[email protected]