This Notice applies to all Field Trip Health and Wellness Ltd., centres and contractors working in such locations.
I. Field Trip’s Legal Obligations
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations. We will provide you with the most recently revised Notice during regular business hours when you visit the office, or we may fax or email it to you if you have agreed to receive electronic communications of this kind. Any changes to our privacy practices will apply to all information we have about you.
II. Uses and Disclosures of Health Information
We typically use or share your health information in the following ways:
For those participating in the Cooperative Ketamine Program, your health information is shared with your therapist.
Bill And Receive Payment For Services
For example, your health plan may request and receive information regarding dates of service, the services provided, and the medical condition being treated.
Health Care Operations
Your health information may be used as necessary to support the day-to-day activities and management of Field Trip. This would include but is not limited to running our practice, improving your care, and for contacting you when necessary. Please note that information is shared among the Professional Corporation that operate Field Trip Health Centres and the Manager. For example, information on the services you received may be used to support quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing, credentialing activities, budgeting and financial reporting, and other activities to evaluate and promote quality.
We are also allowed or required to share your information in other ways, usually which promote the public good such as public health and research. We may have to meet certain conditions in the law before we can share your information for these purposes which include:
To You, Your Family and Friends
We must disclose your health information to you as described in this Notice. We may also disclose your health information to a family member, friend, or other person to the extent it is necessary to do so to assist with your healthcare needs or with payment for your healthcare, but only if you agree that we may do so. If there are individuals to whom you want to give us permission to share such health information with, please let us know by requesting and filling out the necessary form (available upon request).
We may use or disclose your health information to provide you with appointment reminders (such as voice mail messages, text messages, emails, postcards, or letters) unless you direct us not to do so.
To Avert a Serious Threat to Health or Safety
We may use or disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or other person. Any disclosure, however, would only be to someone able to help prevent the threat.
Comply with the Law
We will share information about you if local, state, or federal laws require it.
If you are a member of the armed forces, active or reserve, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Your health information may be disclosed to law enforcement agencies to support government audits and inspections, to facilitate law-enforcement investigations, and to comply with government mandated reporting. For example, we may release medical information if asked to do so by a law enforcement official:
In response to a court order, subpoena, warrant, summons, or similar process;
To identify or locate a suspect, fugitive, material witness, or missing person;
About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
About a death we believe may be the result of criminal conduct;
About criminal conduct at the facility; and
In emergency circumstances to report a crime, or the location of the crime.
Public Health Risks
We may disclose medical information about you for public health activities. These activities generally include the following:
To prevent or control disease, injury, or disability;
To report child abuse or neglect;
To report reactions to medications or problems with products;
To notify people of recalls of products they may be using and to provide your social security number and/or other required information to medical device companies and similar organizations regulated by the U.S. Food and Drug Administration (for example, biologic supply companies and donor banks) so that such organizations may locate you should there be a need to do so;
To notify a person who may have been exposed to a disease, or who may be a risk for contracting or spreading a disease or condition; and
To notify the appropriate government or law enforcement authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Organ and Tissue Donation Requests
If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Work With a Medical Examiner or Funeral Director
We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about you as a patient of the facility to funeral directors as necessary to carry out their duties.
We can use or share health information about you for workers’ compensation claims.
Respond to Lawsuits and Legal Actions
We can share health information about you in response to a court order or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
We may release information to a health oversight agency for oversight activities authorized by law.
Marketing Health-Related Services
We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
We can use or share your information for health research. In some jurisdictions, regulatory approval is required for such use. Generally, absent your consent, any such research will be anonymized.
Other Uses and Disclosures Require Your Prior Written Authorization
Without your authorization, we are expressly prohibited to use or disclose your protected health information for marketing purposes when financial remuneration is involved or for marketing other than face-to-face communication or provision of promotional gifts of nominal value. We may not sell your protected health information without your authorization. We may not use or disclose most psychotherapy notes contained in your protected health information without an authorization. We will not use or disclose any of your protected health information that contains genetic information that will be used for underwriting purposes.
III. Individual Rights
You have certain rights under the federal privacy standards, including Health Insurance Portability and Accountability Act of 1996, as modified in some cases by State laws. These include rights to:
Request an Electronic or Paper Copy of Your Medical Record
If you prefer, we will prepare a summary and or explanation of your health information, also for a fee. Contact us by using the information listed on this Notice for a full explanation of our fees in this regard.
Ask Us to Correct Your Medical Record
You can ask us to correct health information about you that you think is incorrect or incomplete. This request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances, in which case we will provide a written explanation within 60 days of your request.
Request and Receive Confidential Communications
You can ask us to contact you in a specific way (for example, home or office phone) or to send you mail at a different address. We will honor all reasonable requests in this regard.
Ask Us to Limit What We Use or Share
You can ask us not to use or share certain health information for treatment, payment, or health care operations. We are not required to honor your request, and we may say “no” if it would affect your care. Also, if you pay for a service or health care item out of your own pocket in full, you can ask us not to share that information for the purpose of payment with your health insurer. We will honor such requests unless a law requires us to share that information.
Get a List of Those With Whom We Have Shared Information
To request this list, you must submit your request in writing to the address provided in this notice. Your request must state a time period, which may not be longer than six (6) years and may not include dates before the earlier of April 1, 2020 or the opening of your file. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the costs involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Get a Copy of this Privacy Notice
You can ask for a paper copy of this Notice of Privacy Practices at any time, even if you have agreed to receive this notice electronically. Upon request 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 verify that this person has this authority and can act for you before we take any action.
File a Complaint if You Believe Your Rights Have Been Violated
You can complain if you feel we have violated your rights by contacting us as indicated 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 or calling 1-877-696-6755. We will not retaliate against you for filing a complaint.
IV. State Law
Some states have enacted privacy laws or other laws respecting the confidentiality of medical information that have requirements different from, and in some cases more stringent than, those described here. To the extent that an applicable state privacy law imposes requirements that are more restrictive than federal privacy law, the state law will pre-empt the federal law.
The following is a summary of circumstances where your health information may be shared under state laws:
To other health care professionals in certain instances;
To protect against imminent injury to you or others;
In the case of a medical emergency, if we are unable to contain your consent or, in the case of Massachusetts, you refuse to accept further treatment voluntarily;
In certain legal proceedings and/or pursuant to a court order or subpoena;
Pursuant to requests from certain government agencies and programs, such as healthcare or benefits, or for audits, program evaluations, licensure and accreditation activities;
Other than in Massachusetts, for public health purposes;
To law enforcement in certain instances; and
As otherwise permitted or required by relevant State laws.
Please also note that these exceptions are in addition to the uses and disclosures to which you are consenting under this Notice of Privacy Practices and the attached Consent to Treatment and its Schedules.
V. Notice for Residents of Washington State
We keep a record of the health care services we provide you. You may ask us to see and copy that record. You may also ask us to correct that record. We will not disclose your record to others unless you direct us to do so or unless the law authorizes or compels us to do so. You may see your record or get more information about it under the heading “Complaints” below.
If you believe that your privacy rights have been violated, you should contact us immediately. You will not be penalized or otherwise retaliated against for filing a complaint.
VII. Effective Date
This notice is effective as of July 1, 2021.