North Branch Health Montpelier, Vermont

Notice of Privacy Practices

North Branch Health HIPAA Privacy Policy

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Please review it carefully.

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.

Get an electronic or paper copy of your medical record

You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. If you would like a copy, we will provide a copy or a summary of your health information.

If you need a physical copy of your record, we may charge a reasonable, cost-based fee. If you would like this released directly to another practice, they will need to provide a signed release.

We will not release records to third parties, except as related to billing and prior authorizations, without a signed release.

Ask us to correct your medical record

You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

We may say “no” to your request, but we’ll tell you why in writing.

Request confidential communications

You can ask us to contact you in a specific way, such as home or office phone, or to send mail to a different address.

We will say “yes” to all reasonable requests.

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 our operations.

We are not required to agree to your request, and we may say “no” if it would affect your care.

If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for payment or operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

You can ask for a list, also called an accounting, of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

We will include all disclosures except those about treatment, payment, health care operations, and certain other disclosures, such as disclosures you asked us to make.

We’ll provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.

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 make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

You can complain if you feel we have violated your rights by contacting us.

You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights.

We will not retaliate against you for filing a complaint.

Your Choices

You can tell us your choices about what we share.

For certain health information, you have the right and choice to tell us how you want your information shared.

Cases where you have both the right and choice

You can tell us whether to:

  • Share information with your family, close friends, or others involved in your care.
  • Share information in a disaster relief situation.
  • Include your information in a hospital directory.

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

Cases where we need written permission

We never share your information unless you give us written permission for:

  • Marketing purposes.
  • Sale of your information.
  • Most sharing of psychotherapy notes.

In the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.

Uses and Disclosures

How we typically use or share your health information.

Treat you

We can use your health information and share it with other professionals who are treating you.

Example: A provider treating you for an injury asks another provider about your overall health condition.

Run 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.

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

Other Permitted Uses

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.

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease and protecting public health in accordance with relevant state and federal laws.
  • 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.

Do research

We can use or share your anonymized information for health research.

If requested by you, we can share your identifiable health information.

Comply with the law

We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests

We can share health information about you with organ procurement organizations if you are a registered organ donor.

Work with a medical examiner or funeral director

We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and government requests

We can 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.
  • In response to a court or administrative order, or in response to a subpoena.

More information

We have to meet many conditions in the law before we can share your information for these purposes.

For more information, visit HHS HIPAA information for consumers.

Our Responsibilities

Our responsibilities under this notice.

Privacy and security

We are required by law to maintain the privacy and security of your protected health information.

We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

Following this notice

We must follow the duties and privacy practices described in this notice and give you a copy of it.

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.

Changes to This Notice

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, in our office, and on our website.

Contact

North Branch Health

Office Location
250 Main St, Suite 201
Montpelier, Vermont 05602

Mailing Address
PO Box 503
Montpelier, Vermont 05601

Phone
802.828.1234

Fax
802.828.1221

New patient inquiries

Please send all new patient inquiries through the web form on the contact section of the main site.

North Branch Health is part of the Ideal Medical Practice movement, providing care in a welcoming environment.

Contact Us FAQ

Patient Financing

Advance Care Card

North Branch Health is now accepting patient financing through the Advance Care Card.

Important note: North Branch Health has no relationship of any kind with the Advance Care Card and receives no compensation through advertising, clicks, card use, referrals, or any other means.

Contact Us

Send all new patient inquiries through the web form.

We have a small number of openings for ketamine therapy. For other services, we will respond if we have availability, but demand is extraordinarily high at this time.

It may take a few days to respond, and we will only respond if we are able to take new patients. There is no waiting list at this time. If you are a relative of a current patient, please mention that in the form.

Office Location
250 Main St, Suite 201
Montpelier, Vermont 05602

Mailing Address
PO Box 503
Montpelier, Vermont 05601

Phone / Text
802.828.1234

Fax
802.828.1221

Please refer to our Privacy Policy and HIPAA information above before sending any information.