Notice of Privacy Practices

Our legal duties

Tikari is required by law to protect the privacy of your protected health information, to give you this notice explaining our privacy practices, and to follow the terms of the notice that is currently in effect. Protected health information means information that identifies you and relates to your health, your care, or payment for your care.

We will not use or share your information for any purpose other than those described in this notice without your written permission, except where the law requires or permits it.

How we use and share your information for care

We use and disclose your health information for three core purposes without needing separate written permission from you:

Treatment

Your clinician uses your information to assess, diagnose, and treat you, and shares it with others involved in your care. For a post-hospital or chronic care patient this routinely includes your primary care physician, the hospital or emergency department that discharged you, specialists, surgeons, home health agencies, pharmacies, laboratories, imaging centers, and durable medical equipment suppliers. Coordinating with these parties is the core of the service you are buying from us.

Payment

We use your information to bill and collect for services. Some Tikari services are self-pay. If you ask us to bill insurance, Medicare, or Medicaid for a covered service, we will share the minimum information necessary with that payer, which may include your diagnosis and the services provided.

Health care operations

We use your information to run the practice — for example, reviewing the quality of care we provide, keeping records, training, arranging coverage when your clinician is unavailable, and working with our business associates.

Business associates

Some functions are performed by vendors on our behalf, such as our electronic health record, secure messaging, telehealth platform, billing service, and technology hosting. Each vendor that handles your health information is required to sign a business associate agreement obligating it to protect your information under the same standards we follow. You may ask us at any time which categories of vendors currently handle your information, and we will tell you.

People involved in your care

Unless you tell us otherwise, we may share information relevant to your care with a family member, spouse, partner, or other person you have identified as involved in your care or payment. Because much of our work involves coordinating with family caregivers, we will ask you to name who we may speak with, and you may change or withdraw that at any time. If you are not able to agree or object — for example, in an emergency — we will use our professional judgment to share only what is directly relevant to that person's involvement.

Other uses and disclosures permitted by law

The law allows or requires us to use or share your information, without your permission, in these situations:

• When required by law — including reporting required by federal, state, or local law.
• Public health activities — reporting disease, injury, vital events, reactions to medications, and product problems to authorities such as the Delaware Division of Public Health or the FDA.
• Abuse, neglect, or domestic violence — reporting suspected abuse or neglect of a child or vulnerable adult to the authorities designated to receive it. As a practice serving older adults at home, we are a mandated reporter.
• Health oversight — audits, investigations, inspections, and licensure activities by government agencies.
• Judicial and administrative proceedings — in response to a court order, subpoena, or discovery request, as permitted by law.
• Law enforcement — in the limited circumstances HIPAA allows, such as identifying a suspect or victim, reporting a death, or responding to a court order.
• To avert a serious threat — when necessary to prevent or lessen a serious and imminent threat to your health or safety or that of another.
• Coroners, medical examiners, and funeral directors — to allow them to carry out their duties.
• Organ and tissue donation — to organizations that handle procurement and transplantation.
• Workers' compensation — as authorized by workers' compensation laws.
• Military, national security, and correctional institutions — as required for specialized government functions.

We do not participate in research, and we do not use or share your information for research purposes.

Extra protections for certain kinds of health information. Some health information gets extra protection under Delaware and Maryland law, on top of the federal rules, and where a state law protects you more than HIPAA does we follow the law that protects you more.

• HIV information in Delaware. We generally cannot share your HIV test result, or the fact that you were tested, unless you sign a written release naming who may receive it and how long the release lasts — or unless the law specifically allows it, for example to a clinician treating you or to your health plan so your care can be paid for.
• Genetic information in Delaware. Delaware law requires your signed consent before we share genetic test information, with limited legal exceptions.
• Authorizations in Maryland. A form authorizing release of your records must be written, dated, and signed, must name who will receive the records, and generally cannot last longer than one year. It normally covers only the records we created, unless you tell us in writing to include records we received from another provider.
• Mental health and substance use records. These carry additional limits. Where the law lets us share them without your authorization, we share only the part needed for that specific purpose. Records from a federally protected substance use disorder treatment program have their own rules, and in most cases cannot be used against you in a court or administrative case unless you give written consent or a court issues a specific order.

Uses that always require your written permission

We will obtain your written authorization before we:

• Use or share psychotherapy notes, except in the narrow circumstances the law allows.
• Use or share your information for marketing purposes, or send you any communication that is marketing under HIPAA.
• Sell your protected health information. We do not sell your information.
• Use your name, image, story, or testimonial in any promotional material, including on this website or on social media.

You may revoke an authorization in writing at any time. Revoking it stops future uses and disclosures, but does not undo anything already done in reliance on it.

Your rights

You have the following rights regarding the health information we maintain about you. To exercise any of them, contact us using the details below. Most requests should be made in writing.

Get a copy of your records

You may inspect and get a copy of your health and billing records, including an electronic copy if we maintain them electronically. We will respond within 30 days. We may charge a reasonable, cost-based fee for copying and postage. In limited cases we may deny a request, and we will tell you why in writing and explain how to have the denial reviewed.

Ask us to correct your records

If you believe information in your record is incorrect or incomplete, you may ask us to amend it. If we deny the request, we will explain why in writing, and you may submit a statement of disagreement to be kept with your record.

Get a list of disclosures

You may request an accounting of certain disclosures we have made of your information, generally for the six years before your request. Routine disclosures for treatment, payment, and operations are not included. The first accounting in any twelve-month period is free.

Ask us to limit what we use or share

You may ask us to restrict how we use or share your information. We are not required to agree, except for the self-pay restriction described in the next section, which we must honor.

Choose how we contact you

You may ask us to contact you at a specific phone number or address, or to avoid a particular one — for example, asking us not to leave voicemail at a shared home number. We will accommodate reasonable requests and will not ask you to explain why.

Decide who we may speak with

You may tell us which family members or caregivers we may share information with, and you may change that instruction at any time.

Get a paper copy of this notice

You may ask for a paper copy at any time, even if you agreed to receive it electronically. We will provide it promptly.

Be told if your information is breached

We will notify you if a breach occurs that compromises the privacy or security of your information.

Name 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 these rights on your behalf. We will confirm the person has authority before acting.

File a complaint

You may complain to us or to the federal government, as described below, without any penalty or retaliation.

Self-pay restriction right

This right matters at Tikari because some of our services are self-pay. If you pay for a service out of pocket in full, you have the right to instruct us not to disclose information about that service to your health plan for payment or operations purposes, and we are required by law to honor that request. Tell us at or before the time of service so we can flag it in your record.

Complaints

If you believe your privacy rights have been violated, you can complain to us directly using the contact information below, or file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights:

We will never retaliate against you, or reduce or withdraw your care, because you filed a complaint.

Who to contact

For questions about this notice, to exercise any of your rights, or to raise a privacy concern, contact our Privacy Officer:

Changes to this notice

We may change this notice at any time, and the changes may apply to information we already hold about you as well as information we create in the future. The current notice will always be posted on this page with its effective date, will be available in the location where we provide care, and will be given to you on request.