Notice of Privacy Practices (HIPAA)

Effective Date: January 1, 2025
Alleviate Pain and Wellness
850 North Main Street Extension, Building 1, Suite 2C
Wallingford, CT 06492
Phone: 203-626-4203
Fax: 203-626-1624

This Notice describes how your medical information may be used and disclosed, and how you can access your information. Please review it carefully.

Your Rights Under HIPAA

Under federal law (HIPAA), you have the following rights regarding your health information (PHI):

1. Right to Access Your Records

You may request to see or obtain a copy of your medical record and other health information we have about you.

2. Right to Request Corrections

If you believe your health information is incorrect or incomplete, you may request that we correct it.

3. Right to Request Confidential Communications

You may ask us to contact you using a specific phone number, mailing address, or method of communication.

4. Right to Request Limits on Uses and Disclosures

You may ask us not to use or share certain health information for treatment, payment, or operations.
We are not required to agree to all requests, but we will consider them.

5. Right to a List of Disclosures

You may request a list of the times we have shared your health information, who we shared it with, and why.

6. Right to a Copy of This Notice

You may request a paper or electronic copy of this Notice at any time.

7. Right to Restrict Certain Disclosures to Health Plans

If you pay out of pocket in full for a service, you may request that we do not share that information with your health plan.

Your Choices

You may choose how we share certain health information in specific situations, such as:

  • Sharing information with family or caregivers involved in your care

  • Sharing information during emergencies

  • Including your information in a facility directory (if applicable)

If you have preferences about how we share your information, tell us — and we will follow your wishes whenever legally possible.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

1. Treatment

We may use your PHI to provide care, coordinate treatment, or consult with other providers involved in your care (e.g., your primary care provider, specialists, labs, or imaging centers).

2. Payment

We may use your information to verify insurance coverage, submit claims, and obtain payment for services.

3. Healthcare Operations

We may use your PHI for internal operations, such as quality improvement, training, licensing, audits, or compliance.

Other Reasons We May Share Your Information

We may share your information for the following reasons, when required or permitted by law:

  • Public health reporting

  • Preventing or reducing serious threats to safety

  • Health oversight activities

  • Workers’ compensation claims

  • Law enforcement purposes

  • Court or administrative orders

  • Coroners, medical examiners, or funeral directors

  • Organ and tissue donation requests

We will share your information only as allowed by law.

Situations Requiring Your Written Permission

We will not share your PHI without your written authorization for:

  • Marketing purposes

  • Selling your PHI

  • Most uses of psychotherapy notes (not applicable here)

  • Substance use treatment records protected under federal law (42 CFR Part 2)

  • Certain mental health records and HIV-related information under Connecticut law

If you give permission, you may revoke it at any time in writing.

Our Responsibilities

We are required to:

  • Maintain the privacy and security of your health information

  • Provide you with this Notice of Privacy Practices

  • Follow the terms of this Notice

  • Notify you if a breach of unsecured health information occurs

  • Respect your rights regarding your information

We will not use or disclose your PHI in any way not described in this Notice unless you give written authorization.

Changes to This Notice

We may update this Notice at any time.
The updated version will be posted on our website and available in our office with the new effective date.

Questions or Complaints

If you have concerns about your privacy or believe your rights have been violated, you may contact:

Privacy Officer
Alleviate Pain and Wellness
Phone: 203-626-4203
Email: alleviatepainandwellness@gmail.com

You may also file a complaint with:

U.S. Department of Health and Human Services
Office for Civil Rights
https://www.hhs.gov/ocr/privacy/hipaa/complaints/

You will not be penalized for filing a complaint.

Contact Information

For any questions about this Notice or your rights, please contact:

Alleviate Pain and Wellness
850 North Main Street Extension, Building 1, Suite 2C
Wallingford, CT 06492
Phone: 203-626-4203
Fax: 203-626-1624
Email: alleviatepainandwellness@gmail.com