Notice of Privacy Practices of Riverside Lactation LLC
Email address *
NPI# 1821493917 IBCLC# L-20795
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.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 is a federal law designed to protect your privacy whenever your health care providers (including your Riverside Lactation consultant) have to discuss your case or send information about you to different offices. We have to keep a file to record our consult, but we promise you that your private, protected health information (PHI will be kept confidential.

We can freely share all the details of your PHI for the purposes of “treatment, payment, and health care operations.” That means we can talk about your situation and discuss it with your other health care providers. If you are referred to other specialist, we can send the information on to them. We can also share your PHI with your health insurance company if they need it. The law also requires us to share your PHI under other very precise situations: for example, to turn over medical records if a subpoena has been served on us or a federal agency is investigating a complaint that we have not been protecting your privacy.

Any other time we share your PHI, it has to be with your specific authorization: You have to okay it in writing first. For example you may want us to send PHI about your consultation to the Human Resources Department where you work so they can reimburse you under their workplace lactation support program. When you do give us permission to turn over your PHI, we can give out only the minimum amount of information needed to get the job done. Under HIPAA, we can call or write you to remind you to come back for an appointment, or to tell you how you can get a product or service that might interest you and your family.

You have four rights under HIPAA
1.Access (you can ask your Riverside Lactation consultant to see all the PHI she has about you)


2. Amendment (you can ask your Riverside Lactation consultant to change her files to amend inaccurate PHI)

3. Disclosure Accounting (you can ask to whom your Riverside Lactation consultant has given your PHI)


4. Restriction Request (you can put limits on your Riverside Lactation consultant’s use and sharing of your PHI)

Our duty under HIPAA is to give you this notice so you understand we have promised to keep your PHI confidential. If we change this notice in the future, we‘ll give you a new copy. Rachel Blumberg the owner of Riverside Lactation is its Privacy Officer. Our phone number is 703-409-2486. We will answer your questions or concerns about how we protect the privacy of your PHI.

You can complain if you think your privacy hasn’t been protected by your Riverside Lactation consultant and we have a duty to try to resolve things. We can’t penalize you for making a complaint. If we don’t address your complaint adequately, you can make a report to the Office of Civil Rights of the Federal Health and Human Services (HHS) Department to ask that a formal investigation be made. You can’t go to court and sue us over a HIPAA violation, but you can ask HHS to investigate. You can get all the details from them by calling (toll free) at (800) 368-1019 or at their website hhs.gov/ocr/privacyhowtofile.htm.

Please print a copy for yourself.

Your electronic signature below acknowledges you understand and approve the above statements. Please sign and date. *
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Riverside Lactation. Report Abuse - Terms of Service