Notice of Privacy Practices

This notice describes how Firebrand Wellness and Dr. Alisha Ghajar (we, or us) uses or discloses medical information about patients, and how they can get access to this information. Please review it carefully.

You have the right to:

GET A COPY OF YOUR HEALTH AND CLAIMS RECORDS

You may review the personal information Firebrand Wellness has about you by asking, in writing, for access to it or a copy of it. We may charge a fee for copies. In many situations, we will provide the copies in electronic format upon request. 

Except for the exclusions listed below, here are the records you may review and copy:

• Enrollment, payment, claims adjudication, and case or medical management records maintained by or for Firebrand Wellness.

• Other records Firebrand Wellness uses to make decisions about you.

The information you may review and copy does not include:

• Psychotherapy notes.
• Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.
• Information that Firebrand Wellness cannot legally disclose to you.
• Information received from someone other than a healthcare provider under a promise of confidentiality if the access requested would be reasonably likely to reveal the source of the information.

• Information that a licensed healthcare professional or Firebrand Wellness determines should not be disclosed to you because it might harm you or someone else.

ASK US TO CORRECT HEALTH AND CLAIMS RECORDS

• You may ask us to amend your personal information if you believe it is incorrect or incomplete. You must make the request in writing, identify which information you want changed, and explain why it should be changed.
• Firebrand Wellness is not necessarily required to make the changes you request. For example, Firebrand Wellness is not required to change information that we did not create or information that is correct. If Firebrand Wellness does not make the change you request, we will tell you why. 

REQUEST CONFIDENTIAL COMMUNICATIONS

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

REQUEST RESTRICTIONS (LIMITED DISCLOSURES)

• You can ask us not to use or share certain health information for treatment, payment, or our operations.

• We are not required to agree to your request, and we may say “no” if it would affect your care.

GET A LIST OF THOSE WITH WHOM WE’VE SHARED INFORMATION

You may ask for a list of entities to whom Firebrand Wellness has disclosed your information. The list will not include all disclosures. For example, the list will not include:

• Disclosures for treatment, payment, and health care operations.
• Disclosures to you or with your authorization.
• Disclosures made more than six years before your request.

Firebrand Wellness will respond to you within 60 days of your request. If you ask for more than one accounting in any 12-month period, HCA may charge you a reasonable fee.

GET A COPY OF THIS PRIVACY NOTICE

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

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.
• 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 RIGHTS ARE VIOLATED

If you believe your privacy rights have been violated or you have questions:

• Contact Firebrand Wellness by emailing [email protected], calling 1-509-906-4103‬, or writing to Dr. Alisha Ghajar, 522 W Riverside Ave, Suite 4624, Spokane WA 99201; OR
• You can 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.

Your Choices:

For certain health information, you can tell us your choices about what we share. If you have a

clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in payment for your care.
• Share information in a disaster relief situation. 

If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

Our Uses and Disclosures:

How do we typically use or share your health information? We typically use or share your health information in the following ways.

TREAT YOU

• We can use your health information and share it with other professionals who are treating you. (Example: A doctor treating you for an injury asks another doctor about your overall health condition.)

RUN OUR ORGANIZATION

• We can use and share your health information to run our practice, improve care, and contact you when necessary. Sometimes we remove information that identifies you in order to carry out these tasks. (Example: We use health information about you to manage your treatment and services.)

BILL FOR YOUR SERVICES

• We can use and share your health information to bill and get payment from health plans or other entities. (Example: We give information about you to your health insurance plan so it will pay for your services)

HELP WITH PUBLIC HEALTH AND SAFETY ISSUES

• We can share health information about you for certain situations such as:
  • Preventing disease
  • 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

• In certain circumstances, we can use or share your information for health research. Research projects involving patients must be approved through a special review process to protect patient safety, welfare and confidentiality.

COMPLY WITH THE LAW

• We 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 verify that we are complying with federal privacy law.

RESPOND TO ORGAN AND TISSUE DONATION REQUESTS

• We can share health information about you with organ procurement organizations. 

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.

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

RESPOND TO LAWSUITS AND LEGAL ACTIONS

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

ADDITIONAL PROTECTION OF YOUR HEALTH INFORMATION

• Special laws apply to certain kinds of health information. There are extra legal protections for health information about sexually transmitted diseases, drug and alcohol abuse treatment records, mental health records, and HIV/AIDS information. When required by law, we will not share this type of information without your written permission.
• In certain circumstances, a minor (under 18 years of age) patient’s health information may receive additional protections.  

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• 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 information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, in clinical settings, and on our website.