NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
PLEASE REVIEW THIS NOTICE CAREFULLY
Throughout this notice, when we refer to "you" or "your" we are referring to the patient. When we refer to disclosures of information to "you" we mean disclosures to the patient and persons legally authorized to receive information about the patient, such as a minor
patient's parent or a patient’s legal guardian. This Notice of Privacy Practices (this “Notice”) describes your legal rights regarding your
protected health information (“PHI”)* and the legal obligations of Luminary Health under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and, where applicable, Wisconsin State law. Among other things, this Notice describes how your PHI may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted or required by law. We are required to provide this Notice to you pursuant to HIPAA.
HIPAA is a federal law that protects certain medical information known as protected health information or “PHI.” Generally, PHI is individually identifiable health information created or received by a health care provider or a health plan that pertains to:
(1) your past, present or future physical or mental health or condition;
(2) the provision of health care to you; or
(3) the past, present or future payment for the provision of health care to you.
Such PHI is considered “individually identifiable” when it identifies an individual (for example, name, social security number or medical record number) or can reasonably be used to find out the person’s identity (address, telephone number,
birth date, e-mail address, and names of relatives or employers).
WHO FOLLOWS THIS NOTICE
This Notice applies to all PHI created or received by Luminary Health, LLC (the "Provider") in relation to providing you health services at one or more Provider locations in the State of WI and through the use of telehealth services.If you have any questions after reading this Notice, please contact Hannah Huth, via the contact information is listed at the end of this document
OUR PLEDGE TO PROTECT YOUR HEALTH INFORMATION
We are required by law to maintain the privacy of your PHI and provide you with this description of our privacy practices. We will abide by the terms of this Notice.
HOW WE MAY USE AND SHARE YOUR HEALTH INFORMATION WITH OTHERS
Treatment
We may use or disclose your PHI to other health providers for your continuity of care. We may disclose your PHI to physicians, nurses or other health care personnel who provide you with health care services or who are involved in your care. For example, a physician
may review your PHI to determine if a medication is appropriate for your care.
Payment
The Provider will use and disclose your PHI to send bills and collect payment from youfor the care, treatment and other related services you receive from the Provider. Luminary Health operates primarily as a cash-based clinic and does not typically bill insurance. We also may provide your name, address, and health care information to other care providers (for example, your primary care physician) related to your care at the Provider, which may be relevant for and used by such other providers for their own billing and reimbursement
purposes.
Health Care Operations
We may use your health care information as necessary for our individual use and with other organizations that assist us in operating our Provider or programs, which may include quality assurance and improvement activities, evaluation of the performance of health care providers, legal services, risk management business planning and compliance with law. For example, we may use your information to look at the care you received from doctors, nurses, or other health providers to evaluate and/or improve our own systems.
Family and Care Givers
We may disclose limited PHI about you to your spouse, domestic partner, parent, adult child or sibling if such individuals are directly involved in your care or monitoring of your treatment, as verified by your primary care physician orother treating provider. The PHI released would not include alcohol and drug abuse services and would be limited to, a summary of your diagnosis and prognosis, a listing of medications received or you are receiving, and a description of your treatment plan. If you are able and available to agree or object, we will give you the opportunity to agree or object to such uses and disclosures. If you are not available or in the event of your incapacity or in emergency circumstances, we will disclose PHI using professional judgment disclosing only information that is directly relevant to person's involvement in your health care.
Future Communications
The Provider may use your name, address and phone number to contact you to provide newsletters, information about wellness programs or other services we offer. If you would prefer to not receive such communications, contact Hannah Huth, via the contact
information listed at the end of this Notice.
Appointments
The Provider may contact you for appointments using such modes of communication as calls, texts and emails. Messages left for you will not contain specific health information. You may choose to not allow the Provider to leave you messages via a specific mode of
communication by contacting Hannah Huth, via the contact information listed at the end of this Notice.
Telehealth
The Provider engages in telehealth and may exchange your PHI with you via a secure patient portal, email, text messaging, or other telehealth platforms. While reasonable safeguards are used, electronic communications may carry some risk of unauthorized
access. The Provider will obtain your informed consent before engaging with you in telehealth services.
Required by Law
We may use and disclose your PHI when that use or disclosure is required by local, state or federal law. For example, we are required to report actual and suspected abuse, neglect or violence relating to children and the elderly. We are also required to respond to a court order.
Public Health
We may disclose your PHI to local, state or federal public health agencies, subject to the provisions of applicable law, to help prevent or control disease, injury, or disability. For example, we are required to report certain diseases, injuries, and problems with products
and reactions to medications to the Food and Drug Administration.
Health Oversight Activities
We may disclose your PHI to authorities and agencies designated by the government or as required by law, for purposes such as management audits, financial audits or program monitoring and evaluation.
Judicial and Administrative Proceedings
We may disclose your PHI in the course of an administrative or judicial proceeding for such purposes as response to a court order or associated with a petition filed in court related to treatment.
Law Enforcement
We may disclose your PHI to a law enforcement official as required or permitted by law. For example, we may disclose PHI to report an apparent crime, assist with identifying or locating a missing patient, or comply with a court order.
Avert Serious Threats to Health or Safety
We may disclose your PHI in a very limited manner to appropriate persons to prevent a serious threat to the health and safety of a particular person or general public. Disclosure is usually limited to law enforcement personnel who are involved in protecting the public
safety or others in a position to prevent the threat.
For Workers’ Compensation
We may disclose your PHI to the appropriate persons in order to comply with the laws related to Workers’ Compensation or other similar programs. These programs may provide benefits for work-related injuries or illness. We will make reasonable efforts to
limit any workers compensation related disclosures to the minimum necessary to accomplish the intended purpose and only that information that is reasonably related to the injury for which the employee claims compensation.
Correctional Facility, Probation or Parole
If you are an inmate of a correctional facility or under supervision for probation or parole, we may disclose your PHI to the correctional facility, the Department of Corrections, probation and parole agents and other authorized authorities for your health and the health
and safety of others.
WHEN WE ARE REQUIRED TO OBTAIN AN AUTHORIZATION TO USE OR DISCLOSE YOUR HEALTH INFORMATION
Except as described in this Notice, we will not use or disclose your PHI without your written authorization. For example, your authorization is required for most uses and disclosures of PHI for marketing purposes and the sale of PHI. If you authorize us to use or disclose your PHI, you may revoke that authorization, in writing, at any time to stop any future uses and disclosures (to the extent that we have not taken any action relying on the authorization). If you wish to withdraw an authorization that you have provided, please contact Hannah Huth, via the contact information listed at the end of this Notice.
YOUR HEALTH INFORMATION RIGHTS
Right to Request Restrictions
You have the right to request certain restrictions of the Provider's use or disclosure of PHI for treatment, payment or health care operations. You also have the right to request a restriction on our disclosure of your PHI to someone who is involved in your care or the
payment for your care. Note that in many cases we are not required to agree to a restriction. If the Provider does agree to the restriction, it will comply with your request unless an exchange of information is reasonably necessary as a result of your need for emergency treatment. A request for restriction must be made in writing. To request a restriction, you must contact Hannah Huth, via the contact information listed at the end of this Notice.
Right to Inspect and Copy your Health Information
With a few exceptions, you have the right to inspect and obtain a copy of your health information. If you request copies of your health information, we may charge for the costs of providing the copies. If you request an electronic copy and the health information you
are requesting is maintained electronically in a readily producible format, we will provide the copy electronically. Your request to inspect or access your health information must be in writing to: Hannah Huth via the contact information listed at the end of this Notice.
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Right to Send your Health Information to Another
You have the right to request that we transmit a copy of your PHI directly to another individual. Such requests must be in writing on the Provider’s own Authorization for Release of PHI, which is available by contacting Hannah Huth, via the contact information listed at the end of this Notice.
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Right to Receive Confidential Communication of Health Information
You have the right to request that we communicate your PHI to you in a certain way or at a certain location. For example, you may ask that we only contact you at work or by U.S. Mail. Your request must specify how or where you wish to be contacted. We will
accommodate all reasonable requests. Your request for confidential communication of PHI must be in writing to Hannah Huth, via the contact information listed at the end of this Notice.
Right to Amend
If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information for as long as the information is maintained by the Provider. Requests for amending your health information should be made in writing to Hannah Huth via the contact information listed at the end of this Notice. The Provider will respond to your request within 60 days after you submit the written amendment request.
Right to an Accounting of Disclosures
You have a right to request an "accounting of disclosures." This is a list of those people with whom the Provider may have shared your PHI, with the exception of information shared for purposes of treatment, payment, or health care operations or when you have provided us with an authorization to do so. The list of disclosures will be for the previous six years from the date of the request, unless a shorter time period is requested.
The record of disclosures will include the date of each disclosure, who received the disclosed PHI and this individual's address, if known, a brief description of the PHI disclosed, and why the disclosure was made.
Right of Breach Notification
We are required by law to maintain the privacy of PHI and you have the right to be notified if your unsecured PHI has been the subject of a breach.
Right to Complain
If you believe your privacy rights have been violated, you may file a complaint with the Provider or with the Secretary of the Department of Health and Human Services, which can be done through the Office of Civil Rights at the location provided below. Filing a complaint will not affect your care and treatment.
To file a complaint with the Provider, contact Hannah Huth via the contact information listed at the end of this Notice and she will assist you in filing the necessary paperwork. All complaints must be made in writing.
Right to Obtain a Paper Copy of this Notice
Upon your request, you may at any time receive a paper copy of this Notice, even if you earlier agreed to receive this Notice electronically. This Notice is available by contacting Hannah Huth via the contact information listed at the end of this Notice.
Important Note: We reserve the right to revise or change this Notice. Each time you sign a consent for treatment at a site covered by this Notice, we will provide you with a copy of the Notice in effect at that time.
How to Contact Luminary Health:
Hannah Huth, PA-C
262-278-6044
hannah.huth@luminaryhealthwi.com
How to Contact the Department of Health and Human Services:
Office for Civil Rights, Region V
U.S. Department of Health and Human Services
233 North Michigan Ave., Suite 240
Chicago, IL 60601
Voice Phone 800-368-1019
FAX 202-619-3818
TTD 800-537-7697
E-mail: ocrmail@hhs.gov
Effective Date: April 12, 2026
Last Revision Date: April 12, 2026