HIPAA Notice of Privacy Practices

My Commitment to Your Privacy

I, Rafaela Schmidit, IBCLC, am committed to protecting the privacy of your health information. This Notice of Privacy Practices describes how I may use and disclose your protected health information (PHI) and your rights regarding this information.

What is Protected Health Information (PHI)?

PHI is information that:

• Identifies you or could be used to identify you
• Relates to your past, present, or future physical or mental health
• Relates to healthcare services provided to you
• Relates to payment for healthcare services

How I May Use and Disclose Your PHI

For Treatment

I may use your PHI to provide lactation consulting services and coordinate your care. For example:

• Documenting your consultations and creating care plans
• Sharing information with your pediatrician or other healthcare providers involved in your care (with your permission)
• Sending you follow-up recommendations

For Payment

I may use your PHI to obtain payment for services. For example:

• Submitting claims to your insurance company
• Working with The Lactation Network for insurance billing
• Creating superbills for your reimbursement submissions

For Healthcare Operations

I may use your PHI for activities necessary to run my practice. For example:

• Quality improvement activities
• Professional development and training
• Compliance activities

Other Uses and Disclosures

I may also use or disclose your PHI:

• With your authorization: For any purpose not described above, I will obtain your written authorization first
• As required by law: To comply with federal, state, or local laws
• For public health activities: To report diseases or prevent health threats
• To avert serious threat: To prevent serious harm to you or others

Your Rights Regarding Your PHI

Right to Access

You have the right to inspect and obtain a copy of your PHI. To request access, please contact me in writing.

Right to Amend

You have the right to request an amendment to your PHI if you believe it is incorrect or incomplete. I may deny your request in certain circumstances.

Right to an Accounting of Disclosures

You have the right to receive a list of certain disclosures I have made of your PHI.

Right to Request Restrictions

You have the right to request restrictions on how I use or disclose your PHI. I am not required to agree to all requests.

Right to Request Confidential Communications

You have the right to request that I communicate with you in a specific way or at a specific location.

Right to a Paper Copy

You have the right to receive a paper copy of this Notice upon request.

My Responsibilities

I am required to:

• Maintain the privacy of your PHI
• Provide you with this Notice of my privacy practices
• Follow the terms of this Notice currently in effect
• Notify you if there is a breach of your unsecured PHI

Changes to This Notice

I reserve the right to change this Notice and make the new provisions effective for all PHI I maintain. If I make significant changes, I will post the revised Notice on my website and make copies available upon request.

Complaints

If you believe your privacy rights have been violated, you may:

• File a complaint with me directly using the contact information below
• File a complaint with the U.S. Department of Health and Human Services Office for Civil Rights

You will not be retaliated against for filing a complaint.

Contact Information

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

• Rafaela Schmidit, IBCLC
• Email: [email protected]
• Phone: (650) 262-1506

Acknowledgment: By receiving services from Rafaela Schmidit, IBCLC, you acknowledge that you have been provided with this Notice of Privacy Practices and have had the opportunity to ask questions about how your health information will be used and disclosed.