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: November 3, 2020

Purpose

Lucid Lane Providers P.C. 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://lucidlane.com/noticeofprivacypolicy or by contacting the Privacy Official as indicated in the “Contact Information” section of this Notice.

HIPAA and Part 2 

Lucid Lane Providers P.C. is considered to be a “covered entity” that is regulated by the Health Insurance Portability and Accountability Act (“HIPAA”).  Some of the services provided by Lucid Lane Providers P.C. (including some of our services related to medication and substance dependence) (“Covered Services”) may be regulated by and subject to 42 Part 2 (“Part 2”) in addition to the HIPAA requirements. Part 2 significantly restricts how Lucid Lane Providers P.C. may use and disclose your PHI if you are receiving Covered Services.

As many of our clients received Covered Services, Lucid Lane Providers P.C. operationally strives to follow the Part 2 requirements with respect to the use and disclosure of PHI, even where the PHI at issue may not be subject to Part 2. This means that Lucid Lane Providers P.C. may ask for your written consent to use and disclose your PHI for common uses and disclosures like treatment and payment, even when your written consent is not required by law. Above all, Lucid Lane Providers P.C. strives to comply with HIPAA, Part 2 and other state laws as closely as possible in its operations.

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

Lucid Lane Providers P.C. may use or disclose PHI without your prior written consent in the following circumstances:

Medical Emergencies: Lucid Lane Providers P.C. 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 Providers P.C. 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 Providers P.C. may disclose PHI for the purpose of conducting scientific research if Lucid Lane Providers P.C. determines that the recipient of the PHI meets the elements required by Part 2 and HIPAA related to the use and disclosure of PHI for research purposes.

Audits and Evaluation: Lucid Lane Providers P.C. 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 Providers P.C.’s functions.

Court Orders: Lucid Lane Providers P.C. 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 processes.

In addition to the above, certain information is not covered by Part 2 and is therefore subject to use and disclosure without your consent. This includes information related to a client’s commission of a crime against Lucid Lane Providers P.C. personnel, as well as reports of suspected child abuse and neglect made under state law to appropriate state or local authorities. Lucid Lane Providers P.C. must still comply with any applicable HIPAA or other legal requirements when using and disclosing PHI for these purposes.

Uses and disclosures of your PHI that may require your consent

Lucid Lane Providers P.C. may use and disclose your PHI for the purposes set forth below. We have included some examples to help you better understand why these uses and disclosures may occur. To the extent required by Part 2 and/or HIPAA, we will obtain your written consent prior to such use or disclosure. If you are receiving Covered Services, Lucid Lane Providers P.C. will only disclose information identifying you as having, or having had, a substance use disorder if permitted or required by applicable law, including if you provide your written consent for such a disclosure.

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 Providers P.C. 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 Providers P.C. 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 other essential activities. We may also disclose your PHI to third-party “business associates” or “qualified services organizations” that perform various services on our behalfs 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.

General disclosures. Lucid Lane Providers P.C. 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 Providers P.C. 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, 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. In general, we will respond to your request within 30 days of our receipt of your written 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 that 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 Lucid Lane Providers P.C.’s website at  https://lucidlane.com/noticeofprivacypolicy.

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 Providers P.C. 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, Inc.
Attention: Privacy Official
PO BOX 87703
Carol Stream, IL 60188

By Telephone:
(630) 449-4631

By Email:
[email protected]