HIPAA Notice of Privacy Practices
Effective Date: August 13, 2025
This Notice describes how medical and personal information about you may be used and disclosed, and how you
can get access to this information. Please review it carefully.
Our Commitment to Your Privacy
GNHH is committed to protecting your privacy. We create and maintain records of the care and services you
receive. These records include personal, demographic, and health-related information. We are required by federal
law (the Health Insurance Portability and Accountability Act — HIPAA) to:
- Maintain the privacy of your protected health information (PHI)
- Provide you with this Notice of our legal duties and privacy practices
- Follow the terms of this Notice as long as it remains in effect
- Notify you if a breach occurs that may have compromised your protected information
How We May Use and Disclose Your Health Information
We may use or disclose your PHI for the reasons listed below. For each category, NOT every use or disclosure is
listed, but all allowed uses fall within these categories.
A. Treatment
We may use or disclose your information to provide, coordinate, or manage your care. Examples include:
- Sharing information with caregivers or contractors involved in your services
- Consulting with other health providers regarding your needs
B. Payment
We may use or disclose PHI to determine eligibility, bill for services, or obtain payment. Examples:
- Insurance authorization or verification
- Billing statements or documentation
C. Health Care Operations
We may use PHI for activities necessary to run our agency. Examples:
- Quality assessment and improvement
- Staff training and supervision
- Licensing, regulatory, or accreditation reviews
Uses and Disclosures Allowed or Required by Law
We may use or disclose your information without your written authorization in the following circumstances:
A. Public Health Activities
- Reporting adult abuse, neglect, or exploitation
- Preventing or controlling disease
B. Legal Requirements
- We must disclose PHI when required by federal, state, or local law.
C. Health Oversight Activities
- Inspections and audits by licensing or regulatory agencies (e.g., OHCQ)
D. Law Enforcement
- In response to a court order, subpoena, or specific law enforcement request
E. Serious Threat to Health or Safety
- If disclosure is necessary to prevent a serious threat to someone’s health or safety.
F. Workers’ Compensation
- To comply with workers’ compensation laws.
Uses and Disclosures Requiring Your Written Permission
We must obtain your written authorization before:
- Using PHI for marketing purpose
- Sharing information for purposes not listed in this Notice
- Disclosing psychotherapy notes (if applicable)
- Selling your health information
You may revoke your authorization at any time in writing.
Your Rights Regarding Your Health Information
You have the following rights regarding your PHI:
A. Right to Request Restrictions
You may ask us to limit how we use or disclose your PHI. We are not required to agree, except in special
circumstances (e.g., if you pay out-of-pocket in full for a service and request we not disclose it to your insurer).
B. Right to Confidential Communications
You may request to receive information in a specific way (e.g., by mail instead of phone).
C. Right to Access Your Records
You may inspect or request a copy of your PHI. We may charge a reasonable fee for copies.
D. Right to Amend Your Records
If you believe information is incorrect or incomplete, you may request an amendment.
E. Right to an Accounting of Disclosures
You may request a list of certain disclosures made during the past six years.
F. Right to a Paper Copy of This Notice
You may request a printed copy at any time.
G. Right to Be Notified of a Breach
You will be notified if a breach occurs that compromises your PHI.
Our Responsibilities
GNHH is required by law to:
- Maintain the privacy and security of your health information
- Provide you with this Notice
- Notify you if a breach occurs involving your PHI
- Follow the terms of this Notice
GNHH reserves the right to change this Notice at any time. Any changes will apply to all PHI we maintain. Updated
versions will be available upon request and posted in our home office.
Questions or Complaints
If you have questions, concerns, or believe your privacy rights have been violated, you may contact:
GNHH Compliance Department / Administrator
Email: info@gracefulnurturehh.com
Phone: 802-261-2594
You may also file a complaint with:
U.S. Department of Health & Human Services
Office for Civil Rights (OCR)
Online: https://ocrportal.hhs.gov/ocr/
smartscreen/main.jsf
Phone: 1-800-368-1019
TTY: 1-800-537-7697
You will not be penalized or retaliated against for filing a complaint.
Acknowledgment of Receipt (Internal Use Only)
A separate form will be provided for clients to acknowledge receiving this Notice.
This Notice describes your legal rights. Please keep it for your records.
