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The One Tribe, Inc.

NOTICE OF PRIVACY PRACTICES

NOTICE
This Notice of Privacy Practices 
describes how medical information about you 
may be used and disclosed and 
how you can get access to this information. This notice is for information only.
Please review it carefully.

Effective date: This notice takes effect on November 1, 2023, and stays in effect until replaced by another notice.

The One Tribe, Inc., and its affiliates (collectively “The One Tribe,” “Us,” “we,” or “our”) takes the privacy of your Protected Health Information very seriously. “You” and “Your” means the individual who seeks to be provided or is provided healthcare services by Us, and includes the person’s authorized legal representative, if any.

Federal and state laws require us to protect the privacy and security of your health information.

Your Information. Your Rights. Our Responsibilities.

This notice describes your rights and our responsibilities over your health information.

Your Rights.

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

You have the right, by contacting us using the Contact Information below, to:

  1. Get a paper copy of this notice even if you received an electronic copy.
  2. You may ask to see or get a copy of your health and claims records and other health information that we have about you.
    • We will provide a copy or a summary of your health and claims records in the format of your choice (paper, electronic, digital), usually within 30 days of your request.
    • We may charge a fee to cover the costs of copying, packaging, or mailing the information.
  3. Ask to correct your paper or electronic medical record.
    • You may ask us to correct your electronic and paper health and claims records if you think there is an error or if it is incomplete.
    • We may say “no” to your request, but we will give you a reason in writing within 60 days.
  4. Request confidential communications.
    • You may ask us to contact you in a specific way (for example: by cell or by office phone) or to send mail to a different address.
    • We are not required to agree to your request. We will consider all reasonable requests.
    • If you are in danger if we do not use the alternative contact information, we will agree to this request.
  5. Ask us to limit the information we share.
    • You may 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. We will consider all reasonable requests.
    • If you are in danger if we do not use the alternative contact information, we will agree to this request.
  6. Get a list of those with whom we have shared certain information about you.
    • You may ask for a list of times that we have shared your health information, including who we shared it with and why we shared it. This list only covers information shared in the six years before the request date.
    • We will include all health information disclosures except for those about treatment, payment, and health care operations, as well as certain other disclosures (such as any disclosures we made to you).
    • We will provide one set of records each year for free. If you ask for another set of records within 12 months, we will charge a fee to cover the costs of copying, packaging, or mailing the information.
  7. Choose someone to act for you.
    • If you want, you may give someone the right to act for you (examples: legal guardian, authorized representative, power of attorney and more). That person can exercise your rights and make choices about your health information. That person must show written proof that they have the right to act for you.
    • We will make sure the person has the proper authority and can act for you before we honor their request for your health information. We may ask the person to verify their identity (examples: driver’s license, state ID, court order, passport).
  8. File a complaint if you feel your rights are violated. There will be no retaliation for filing a complaint.
    • If you believe your privacy rights have been violated, you may file a complaint by contacting Us at the address listed above. All complaints must be made in writing.
    • You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, Region VI, 1301Young St., Suite 1169, Dallas, TX 75202. You can call 800-368-1019 (toll-free), fax 214-767-0432 or visit www.hhs.gov/ocr/privacy/hipaa/complaints. If you are hearing or speech impaired, you may call 800-537-1697 (TTY).
    • For complaints regarding the violation of your right to confidentiality by an alcohol or drug abuse treatment program, contact the United States Attorney’s Office for the judicial district where the violation happened.

Your Choices.

You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition
  • Provide disaster relief
  • Include you in a hospital directory
  • Provide mental health care
  • Market our services and sell your information
  • Raise funds. We may contact you for fundraising efforts, but you can tell us not to contact you again.

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and 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.

In these cases, we never share your information unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes
  • Sharing of Substance Use Disorder Information

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.

  1. Treating you
    We can use your health information and share it with other professionals, often those under contract with us, who are treating you. Example: A psychologist treating you for mental health may ask another provider about your overall health condition.

  2. Running our organization
    We can use and share your health information to run our practice, improve your care, and contact you when necessary. Example: We use health information about you to manage your treatment and services.

  3. Billing for your services
    Though we do not bill third-party payors for your care, and we expect any payment due directly from you, we may use and share your health information to prepare a document you can send to a payor like a health plan for payment or reimbursement for your care. Example: We give information to you about your care you may send to your health insurance plan so it will pay for or reimburse you for our services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Your information can help Us:

  1. Address public health and safety issues.
    We may share health information about you for certain situations:

    • 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

  2. Do research

    • We may use or share your information for health research.

    • We make efforts to protect your information.

  3. Comply with the law.
    We will share information about you if state or federal laws require it, including with the U.S. Department of Health and Human Services if it wants to see if we are complying with federal privacy law.

  4. Respond to organ and tissue donation requests and work with medical examiner or funeral director.

    • We may share health information about you with organ donation organizations if you are an organ donor.

    • We may share your health information with a coroner, medical examiner, or funeral director.

  5. Address workers’ compensation, law enforcement and other government requests.
    We may 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.

  6. Respond to lawsuits and legal actions.

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

  7. Protect your health and safety.

    • For certain health information, you can tell us your choices about what we share. If you cannot tell us your preferences — 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 reduce a serious and immediate threat to health or safety.
    • Without your permission, we will not share this information except in the situations described above.
    • We never share your information unless you give us permission for:
    • Market and fundraise
    • Sell your information
    • We will always obtain your authorization to use or share your psychotherapy notes, if there is a payment from a third party, or for any other disclosure not described in this notice or required by law. You have the right to cancel your authorization by writing to the privacy division below.
    • We will always obtain your authorization to use or disclose substance use information about you.

Our Responsibilities

  1. We are required by law to maintain the privacy and security of your protected health information.
  2. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
  3. We must follow the duties and privacy practices described in this notice and give you a copy.
  4. 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, the Health Insurance Portability and Accountability Act of 1996: 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, provided at your next office visit, posted in our office, and provided to via our web site: www.theonetribe.com.

CONTACT US to request help making records or privacy requests:

ATTN: Privacy Official
One Tribe, Inc.
2200 Biscayne Blvd., 2nd Fl.
Miami, FL 33137
(305) 703-0003
[email protected]

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