Privacy & Client Rights

Notice of Privacy Practices

This summary describes how health information about you may be used and disclosed, and how you can get access to it. Please review it carefully. Our complete Notice of Privacy Practices is available at our front desk, and we are happy to send you a copy on request.

How we use your information

We use and share your health information to provide your care, to receive payment for services, and to run our agency, as allowed by the Health Insurance Portability and Accountability Act (HIPAA) and Ohio law. Other uses, such as most marketing, need your written permission, and you may take that permission back at any time.

Your rights

• See and get a copy of your health records
• Ask us to correct information you believe is wrong or incomplete
• Ask us to contact you in a certain way or at a certain place
• Ask us to limit what we use or share
• Get a list of certain times we have shared your information
• Get a paper copy of our full notice
• Choose someone to act for you
• File a complaint if you feel your rights were violated

To use any of these rights or to file a complaint, contact our Privacy Officer at 440.569.1075 or info@createaspacecle.com. You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights at hhs.gov/ocr/complaints. We will never retaliate against you for filing a complaint.

About this website

The contact form on this website sends a regular email. Please do not include health details, diagnoses or insurance numbers in it. Our team will collect that information safely when we follow up with you.

Client Rights & Responsibilities

Every person who comes to Create A Space Wellness Studio has the right to:

• Be treated with dignity, respect and kindness
• Receive care in a safe setting, free from abuse, neglect and exploitation
• Take part in creating your own care plan and set goals that matter to you
• Receive clear information about your services, your rights and your costs
• Keep your information confidential, except where the law requires otherwise
• Refuse or stop any service at any time
• Voice a concern or file a grievance without fear of losing services

We ask clients and members to respect others in our community, keep appointments or let us know when plans change, and share honest information so we can provide the best care. To share a concern or file a grievance, please speak with any team member or contact us at 440.569.1075.

Your Right to a Good Faith Estimate

You have the right to receive a "Good Faith Estimate" explaining how much your medical care will cost.

Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.

• You have the right to receive a Good Faith Estimate for the total expected cost of any non emergency items or services. This includes related costs like medical tests, prescription drugs, equipment and hospital fees.
• Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
• If you receive a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
• Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1.800.985.3059.

Nondiscrimination & Language Help

Create A Space Wellness Studio complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex. We do not exclude people or treat them differently because of these characteristics.

We provide free aids and services to people with disabilities so they can communicate with us effectively, and free language services, including qualified interpreters, to people whose primary language is not English. If you need these services, please call 440.569.1075.

If you believe we have failed to provide these services or discriminated in another way, you can file a grievance with us in person, by phone or by email. You can also file a civil rights complaint with the U.S. Department of Health and Human Services Office for Civil Rights at ocrportal.hhs.gov.