This Notice of Privacy Practices (“Notice”) describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.
At Rooted Northeast Florida, LLC d/b/a Nueva Vida Pelvic Floor Therapy and Women’s Health Collective, we are committed to treating and using protected health information (“PHI”) about you responsibly. This Notice describes the PHI we collect, and how and when we use or disclose that information. It also describes your rights as they relate to your PHI. This Notice applies to all PHI, as defined by federal regulations.
When it comes to your PHI, you have the following rights:
Get an electronic copy of your medical record.
You can request a hard copy or an electronic copy of your medical record and other PHI we have about you.
We will provide a copy or a summary of your PHI, usually within thirty (30) days of your request. We may charge a reasonable, cost-based fee in providing hard copies of such records.
Ask us to correct your medical record.
You can ask us to correct PHI about you that you think is incorrect or incomplete.
We reserve the right to deny your request, but we will explain the reason for such denial, in writing, within sixty (60) days of your request.
Request confidential communications.
You can ask us to contact you in a specific way (for example, home or cell phone) or to send mail to a different address.
We will say “yes” to all reasonable requests.
Ask us to limit what we use or share. You can ask us not to use or share certain PHI for treatment, payment, or our operations.
We reserve the right to deny your request if such request would adversely affect your care, in our professional opinion.
Get a list of those with whom we have shared information.
You can request a list (accounting) of the times we have shared your PHI for six (6) years prior to the date you ask, who we shared it with, and why we shared it.
We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We will provide one (1) accounting a year for free but will charge a reasonable, cost-based fee if you request additional accountings within twelve (12) months.
Get a copy of this Notice.
You can ask for a paper copy of this Notice at any time, even if you have agreed to receive this Notice electronically.
We will provide you with a paper copy promptly, upon your request.
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 PHI.
We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your privacy rights are violated.
If you feel we have violated your privacy rights, you can contact us using the information provided under “CONTACT INFORMATION” below.
You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
For certain PHI, you can tell us your choices about what we share. If you have a clear preference for how we share your PHI in the situations described below, please advise us, and we will follow your instructions.
You have both the right and choice to tell us to share PHI with your family, close friends, or others involved in your care.
If you are not able to tell us your preference, for example, if you are unconscious, we may proceed with sharing your PHI if we believe it is in your best interest. We may also share your PHI when needed to lessen a serious and imminent threat to your health or safety.
In the following cases, we never share your PHI unless you give us written permission:
Sale of your PHI.
In the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
How do we typically use or share your PHI? We typically use or share your PHI in the following ways:
Treat you. We can use your PHI and share it with other professionals who are treating you.
Example: An occupational therapist providing pelvic floor therapy asks another doctor about your overall health condition.
Run our organization. We can use and share your PHI to run our practice, improve your care, and contact you when necessary.
Example: We use PHI about you to manage your treatment and services.
How else can we use or share your PHI? We are allowed or required to share your PHI in other ways – usually in ways that contribute to the public good, such as public health and research. We are required to meet certain conditions pursuant to applicable law before we can share your PHI for these purposes.
Help with public health and safety issues. We can share PHI about you for certain situations, such as:
Helping with product recalls.
Reporting adverse reactions to medications.
Reporting suspected abuse, neglect, or domestic violence.
Preventing or reducing a serious threat to anyone’s health or safety.
Do research. We can use or share your PHI for health research.
Comply with the law. We will share PHI 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 law.
Respond to workers’ compensation, law enforcement, and other government requests. We can use or share PHI 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.
In response to a court or administrative order, or in response to a subpoena.
We are required by law to maintain the privacy and security of your PHI.
We will promptly advise you if a breach occurs that may have compromised the privacy or security of your PHI.
We must follow the duties and privacy practices described in this Notice and give you a copy of it.
We will not use or share your PHI other than as described in this Notice unless you advise us in writing; provided, that, you may change your mind at any time by providing us written notice.
For more information, see:
If you have questions and would like additional information, you may contact us via mail or email, as follows:
Rooted Northeast Florida, LLC
d/b/a Nueva Vida Pelvic Floor Therapy and Women’s Health Collective
Attention: Sara Bonderud
11111 San Jose Boulevard
Jacksonville, FL 32223
Changes to the Terms of this Notice
We can change the terms of this Notice, and the changes will apply to all PHI we have about you. The revised Notice will be available upon request and on our website.
Effective August 21, 2023.