Jennifer Jensen, IBCLC
Notice of Privacy Practices
My Pledge Regarding Your Health Information
I am committed to protecting the privacy of “protected health information” about you, as that term is defined in the privacy regulations issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). With certain limited exceptions, protected health information is generally defined as information that identifies an individual or that reasonably can be used to identify an individual, and that relates to the individual’s past, present, or future payment for healthcare provided to that individual. For simplicity, I will refer to protected health information as “health information” in this notice. My privacy practices concerning your health information are as follows:
I will safeguard the privacy of health information that I have created or received as required by law.
I will explain how, when, and why I use and/or disclose your health information.
I will comply with the provisions of this Notice and only use and/or disclose your health information as described in this Notice.
I will provide notice of a breach of unsecured health information.
How I May Use and Disclose Your Health Information
The following categories describe different ways that I may use and disclose health information:
For Care. I may use your health information to provide, coordinate, or manage your care and related services. This may include communication with other health care providers regarding your care and coordinating and managing your healthcare with others. For example, your baby’s pediatrician may need to know whether your baby’s weight gain is appropriate in order to develop an appropriate plan of care. Your maternity care provider may need to follow up with you regarding pain or skin breakdown on your breasts.
For Payment. At this time I only accept cash payments, but I do provide a superbill to patients upon request. In general, I do not get involved in your insurance billing as I am not credentialed with your insurance provider. However, because I issue superbills, there may be rare occasions when I need to communicate with a health insurance provider regarding services that I provided to you.
Contacting You. I may use and disclose health information to contact you about appointments, clinical instructions, surveys, billing, or general communications. I may contact you by mail, telephone, email, or text message when you provide your address, telephone number, email address, or mobile phone number. There is a risk that someone else could read or access unencrypted emails or text messages. If you do not wish to receive these types of text or email messages, please contact me at privacy@jenniferjensen.org.
De-identified Health Information. I may use your health information to create “de-identified” information that is not identifiable to any individual in accordance with HIPAA. I may create data sets of de-identified information of many patients to share with outside persons and companies to discover new ways to improve care for postpartum families. I may also disclose your health information to a business associate for the purpose of creating de-identified information.
Limited Data Set. I may use your health information to create a “limited data set” by removing certain identifying information. I may also disclose your health information to a business associate for the purpose of creating a limited data set. I may use and disclose a limited data set only for research, public health, or health care operations purposes. I may create a limited data set of many patients to share with outside persons and companies to perform research, public health or health care operations. Persons or companies receiving the limited data set must sign an agreement to protect your health information.
Electronic Health Information Exchange (HIE) and other de-identified data partnerships. I may participate in certain HIEs that permit health care providers or other health care entities, such as your health plan or health insurer, to share your health information for treatment, payment and other purposes permitted by law, including those described in this Notice.
Business Associates. I may need to hire business associates to provide services, such as an accountant or attorney. When I hire people to perform these services, I may disclose your health information to these companies so that they can perform the job we have asked them to perform. To protect your health information, I require the business associate to appropriately safeguard your health information.
Individuals Involved in Your Care or Payment for Your Care. I may share with a family member, relative, friend, or other person identified by you, health information that is directly relevant to that person’s involvement in your care or payment for your care. I may use or disclose health information in order to notify a family member, personal representative, or other person responsible for your care of your location, general condition or death. In addition, I may disclose health information about you to an entity assisting in a disaster relief effort so that your family, personal representative or others responsible for your care can be notified about your location, general condition or death. If you do not want health information about you used or disclosed in the above circumstances, please privacy@jenniferjensen.org. I will comply with additional state law confidentiality protections if you are a minor and receive treatment for pregnancy, drug and/or alcohol abuse, communicable disease, or mental health.
Special Situations
I may use and/or disclose health information about you for a number of circumstances in which you do not have to consent, give authorization or otherwise have an opportunity to agree or object. Those circumstances include:
As Required by Law. I will disclose your health information when required to do so by federal, state, or local law or other judicial or administrative proceedings. For example, I may disclose your health information in response to an order of a court or administrative tribunal.
To Avert a Serious Threat to Health or Safety. I may use and disclose your health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or reduce the threat.
Public Health Risks. We may disclose your health information to appropriate government authorities for public health activities. These activities generally include to prevent or control disease injury or disability; or to report child abuse or neglect.
Health Oversight Activities. I may disclose your health information to a federal or state health oversight agency for oversight activities authorized by law.
Law Enforcement. I may release health information to a law enforcement official for certain law enforcement purposes. Please know that disclosure of drug use is treated as confidential and will not be reported to law enforcement except as it is related to one of the public health risks described above.
Lawsuits and Disputes. In the course of any judicial or administrative proceeding, I may disclose your health information in response to a court or administrative order, subpoena, discovery request, or other lawful process.
Your Health Information Rights
You have the following rights regarding the health information I maintain about you:
Right to Inspect and Copy. You have the right to inspect and obtain a copy of your health information. To inspect and obtain a copy your health information, please e-mail privacy@jenniferjensen.org for instructions on how to submit your written request. If you request a copy of the health information, I may charge a fee for the costs of copying, mailing or other supplies associated with your request. I will respond to you within 30 days of receiving your written request. Under certain situations, I may deny your request in writing, describing the reason for denial and your rights to request a review of our denial.
Right to Amend. You have the right to request that I make amendments to clinical, billing and other records used to make decisions about you. Your request must be in writing and must explain your reason(s) for the amendment. I may deny your request if the health information is not part of the health information used to make decisions about your care, or if I believe the health information is correct and complete. I will tell you in writing the reasons for the denial and describe your rights to give us a written statement disagreeing with the denial. If I accept your request to amend the health information, I will make reasonable efforts to inform others of the amendment, including persons you name that have received your health information. Please e-mail privacy@jenniferjensen.org to request an amendment to your record.
Right to an Accounting of Disclosures. You have the right to receive a written list of certain disclosures I made of your health information. You may ask for disclosures made, up to six (6) years before your request. I am required to provide a listing of all disclosures, except the following:
For treatment, payment, or health care operation purposes.
Occurring as a byproduct of permitted uses and disclosures.
Made to or requested by you or that you authorized.
Made to individuals involved in your care, or for disaster relief purposes.
Made as part of a limited data set which does not contain health information which would identify you.
The list will include the date of the disclosure, the name (and address, if available) of the person or organization receiving the health information, a brief description of the health information disclosed, and the purpose of the disclosure. To request this list or accounting of disclosures, please e-mail privacy@jenniferjensen.org.
Right to Request Restrictions. You have the right to request that I restrict the use and disclosure of your health information. I am not required to agree to your requested restrictions, except I will honor your request to not disclose to your health plan if the disclosure is for payment or healthcare operations purposes (and is not otherwise required by law) and the health information pertains solely to items or services for which you have paid out of pocket in full. If I agree to your request, there are certain situations when I may not be able to comply with your request. These situations include emergency treatment, disclosures to the Secretary of the Department of Health and Human Services, and uses and disclosures that do not require your authorization. You may request a restriction by e-mailing privacy@jenniferjensen.org.
Right to Request Confidential Communication (Alternative Ways). You have the right to request confidential communications, i.e., how and where I contact you, about your health information. For example, you may request that I contact you at your work address or phone number. Your request must be in writing. I will accommodate reasonable requests, but when appropriate, may condition that accommodation on you providing me with information regarding how payment, if any, will be handled and your specification of an alternative address or other method of contact. You may request alternative means of communications by e-mailing privacy@jenniferjensen.org.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice upon request. I will make available a copy of this Notice to you no later than the date you first receive service from me. You may also obtain a copy of this Notice at any time from my website, www.jenniferjensen.org.
My Responsibilities
Protect Your Privacy. I am required to maintain the privacy of your health information. In addition, I am required to provide you with a notice of our legal duties and privacy practices with respect to information I collect and maintain about you.
Adhere to this Privacy Notice. I must abide by the terms of this notice. I reserve the right to change my practices and to make the new provisions effective for all the protected health information I maintain. If my information practices change, the new notice will be posted on that website. Your health information will not be used or disclosed without your written authorization, except as described in this notice. Except as noted above, you may revoke your authorization in writing at any time.
Contact for Questions and Complaints
If you have any questions regarding this Notice, our privacy policies or if you believe your privacy rights have been violated or you wish to file a complaint about my privacy practices, you may contact privacy@jenniferjensen.org. You may also send a written complaint to the United States Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint. Their contact information is:
U.S. Department of Health and Human Services
Office of the Secretary
200 Independence Avenue, S.W.
Washington, D.C. 20201
Tel: (202) 619-0257
Toll Free: 1-877-696-6775
Changes to this Notice
This Notice was last revised on December 9, 2024. I reserve the right to change the terms of this Notice and to make new notice provisions effective for all health information that we maintain by:
Posting the revised Notice on my website, www.jenniferjensen.org.
Making copies of the revised Notice available upon request.