Notice of Privacy Practices
Last updated 9 January 2024
IPNAM Health, LLC is a sole-proprieter private practice established by Dr. Samantha A. Miller. All services are provided by Dr. Miller with the exception of maintenance of the electronic medical record and phone services, which are handled securely by third-party HIPAA compliant sites. Credit card payments also are managed by a third-party secure site. This Notice describes how medical information about you may be used and disclosed by IPNAM Health, LLC, and how you can access this information. Please review it carefully.
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What you will find...
YOUR CHOICES - DISCLOSURE OF PERSONAL HEALTH INFORMATION
CHANGES TO THE TERMS OF THIS NOTICE
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YOUR RIGHTS
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Obtain a copy of your electronic medical record
• You may ask to see or get an electronic or paper copy of your medical record at any time. A copy of your health information will be provided usually within 30 days of your request. There may be a reasonable, cost-based fee for processing this request.
• For your convenience, use of the patient portal is recommended to see your health information. If you need assistance accessing the portal Dr. Miller may provide guidance.
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Correct your medical record
• You may ask Dr. Miller to correct information about you in your medical record that you think is incorrect or incomplete. You are encouraged to raise any concerns during session. You also may submit a written request via the patient portal.
• It is possible that Dr. Miller will decline your request. If that is the case, Dr. Miller will discuss this decision with you during session and provide an explanation in writing within 60 days.
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Confidential communications
• You may ask Dr. Miller to contact you in a specific way. For example by phone, mail or secure message. Dr. Miller will attempt to accommodate all reasonable requests. To protect confidentiality, text and email communications are not offered.
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Limiting what is used and shared
• You may ask Dr. Miller not to use or share certain health information for treatment, payment, or operations. Dr. Miller is not required to agree to your request, and may say “no” if it would affect your care.
• If you pay for a service or health care item out-of-pocket in full, you may ask Dr. Miller not to share that information with your health insurer. Dr. Miller will say “yes” unless a law requires that the information be shared. Please keep in mind that if you submit a claim to your insurer for reimbursement, a diagnosis and billing code is required and included on your invoice.
• Please keep in mind that if you submit a claim to your insurer for reimbursement, a diagnosis and billing code is required and included on your invoice. As well, if you utilize insurance for prescriptions, this information also will enter an insurance information bureau. This circumstance may have consequences for you later if/when you apply for new insurance policies (examples: health, life and/or disability insurance).
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Get a list of those with whom we’ve shared information
• You may ask for a list of the times and with whom Dr. Miller has shared your health information for six years prior to the date you ask. Disclosures for treatment, payment, and health care operations, and certain other disclosures (such as any you requested) may not be included. Dr. Miller will provide this summary once every 12 months for free. Additional requests will incur a reasonable, cost-based fee.
Get a copy of this Privacy Notice
• You may ask for a paper copy of this Notice at any time, even if you initially agreed to receive the Notice electronically. Dr. Miller will provide you with a paper copy promptly.
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Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• Dr. Miller will make sure the person has this authority and can act for you before any action is taken.
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File a complaint if you feel your rights are violated
• You may complain if you feel Dr. Miller has violated your rights by contacting her directly. You may send a written message using the secure patient portal, or call the office at 1-800-944-7004.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to Centralized Case Management Operations, 200 Independence Avenue, S.W., Room 509F HHH Building , Washington, D.C 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/civil-rights/filing-a-complaint/index.html
• Dr. Miller will not retaliate against you for filing a complaint.
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YOUR CHOICES - DISCLOSURE OF PERSONAL HEALTH INFORMATION
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In certain circumstances you may let Dr. Miller know your choices about what information is shared. You have both the right and choice to tell Dr. Miller whether to share information with your family, close friends, or others involved in your care. Dr. Miller will try to accommodate your requests whenever possible.
However, there are some cases where Dr. Miller may share personal health information without your direct permission. Please note the following examples of circumstances were Dr. Miller may do so.
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If you are not able to share your preference, Dr. Miller will share your information if she believes it is in your best interest to do so. Example: If you are unconscious.
Dr. Miller will share your information when needed and as required by law if there is concern about an imminent risk to your health and safety, or to the health and safety of people around you, through your actions. Dr. Miller also is obligated by law to report concerns about the abuse or neglect of children and vulnerable adults. Dr. Miller may alert the local police, Child Protective Services, Adult Protective Services, or other applicable persons or agencies to fulfill these obligations.
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In the following cases Dr. Miller will not share your information unless you provide written permission:
• Marketing purposes
• Sale of your information​
• Most sharing of psychotherapy notes
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In the case of marketing & fundraising:
• We may contact you for marketing and fund raising efforts, but you can tell us not to contact you again.
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Health Information Exchange:
• Dr. Miller may participate in certain health information exchanges that share health information electronically with other healthcare providers, as permitted by Maryland and federal law.
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OTHER USES AND DISCLOSURES​
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How does Dr. Miller typically use or share your health information?
Dr. Miller typically will use or share your health information to:
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Treat you
Dr. Miller can use your health information to treat you and share it with other professionals who are treating you.
Example: A doctor treating you asks another doctor about your overall health condition.
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Run IPNAM Health
Dr. Miller can use and share your health information to run the practice, improve your care, and contact you when necessary.
Example: Use health information about you to manage your treatment and services.
Bill for services
IPNAM Health can use and share your health information to bill and get payment from health plans or other entities. Currently Dr. Miller bills Medicare. Dr. Miller does not bill private commercial insurance companies. Dr. Miller will provide an itemized bill to you directly through the patient portal system within 72 hours after your visit. Please keep in mind that if/when you submit a medical claim to your insurance company for reimbursement, that bill will include a diagnosis and billing code. Use of insurance to pay for prescription medications also will result in this information being entered in an insurance information bureau.
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Comply with the law
Dr. Miller will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we are complying with federal privacy laws as part of their compliance reviews.
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Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations for organ, eye or tissue donation or transplantation.
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Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
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Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services
Help with public health and safety issues
• Preventing disease. Some conditions have a mandatory reporting requirement at time of diagnosis. For example, sexually transmitted infections such as HIV, hepatitis and syphilis must be reported to the local health department.
• Helping with product recalls​
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence as per above
• Preventing or reducing a serious threat to anyone’s health or safety as per above
Respond to lawsuits and legal actions
Dr. Miller can share health information about you in response to a court or administrative order or in response to a subpoena if certain requirements are met.
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Any additional required disclosures of health information by Dr. Miller not specified in this Notice will occur only if/when professional and legal standards for disclosure in mental health treatment are met For more information see: https://www.hhs.gov/hipaa/index.html
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PRACTICE RESPONSIBILITIES​
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• Dr. Miller is required by law to maintain the privacy and security of your protected health information.
• Dr. Miller will inform you promptly if a breach occurs that may have compromised the privacy or security of your information
• Dr. Miller must follow the duties and privacy practices described in this Notice and give you a copy of it.
• Dr. Miller will not use or share your information other than as described here unless you provide written permission, or unless required by law. If you change your mind after agreeing to a disclosure you may advise Dr. Miller in writing and that change will be honored.
For more information see: https://www.hhs.gov/ocr/about-us/index.html.
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CHANGES TO THE TERMS OF THIS NOTICE​
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Dr. Miller can change the terms of this Notice, and the changes will apply to all information Dr. Miller has about you. The new Notice will be available upon request and on the IPNAM Health, LLC website.
OTHER INSTRUCTIONS FOR NOTICE
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• In addition to the federal rules regarding privacy, Dr. Miller will follow Maryland State laws regarding health care privacy. Dr. Miller will obtain appropriate consents before sharing information concerning your genetic information, HIV status, substance abuse and certain mental health information. Dr. Miller also will obtain your consent for other uses and disclosures of your health information when required by Maryland law to do so.
ADDITIONAL QUESTIONS?
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If you have any additional questions about our Privacy Policy please call 1-800-944-7004.
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Depending on where you live, you may have a right to lodge a complaint with a supervisory authority or other regulatory agency if you believe that IPNAM Health, LLC has violated any of the rights concerning your personal information. We encourage you to reach out to Dr. Miller so we may have an opportunity to address your concerns directly before you do so.
Thank you.