HIPPA Privacy Notice
Effective date: 1/1/17
Key Pointe Medical Weight Loss & Wellness Center, LLC (DBA: “Your Wellness Center”) is covered by regulations pursuant to the Health Insurance Portability and Accountability Act of 1996 (“HIPPA”) and is required by law to maintain the privacy of your health information, give you notice of our privacy practices with respect to your medical information, notify you of any breaches of your unsecured medical information and abide by the terms of this Notice. This Notice applies to the records of your care generated and maintained by Your Wellness Center.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
The following categories describe different ways that we may use and disclose your medical information. These are examples and therefore, not every permitted use and disclosure is listed.
We may use medical information about you:
- To provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students and other trainees, or other personnel who are involved in taking care of you at our health care facility. We may also disclose medical information about you to people outside of our health care facilities who may be involved in your medical care after you leave the health care facility, such as other physicians involved in your care.
- So that the treatment and services you receive at our health care facility may be billed to and payment may be collected from you, an insurance company, or a third party when applicable.
- To run the health care facility and make sure that our patients receive quality health care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may use and disclose medical information about you for various quality assurance and quality improvement activities. We may also provide medical information to other healthcare providers who have a relationship with you and need the information for their own healthcare operations.
- To our business associates who need that information in order to provide a service to us or on behalf of us. A business associate is a person who is not part of the health care facility’s workforce, a company or other entity which uses or has access to protected health information in order to perform a function on behalf of the health care facility. For example, billing companies, document shredding companies, consultants, and attorneys.
- To contact you as a reminder that you have an appointment at the health care facility.
- To tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- To tell you about health-related benefits or services that may be of interest to you.
- For research purposes.
- When required to do so by federal, state or local law.
- When necessary to prevent a serious threat to the health and safety of you, the public, or another person.
- For worker’s compensation or similar programs which provide benefits for work-related injuries or illness.
- For public health activities such as the prevention or control of disease, injury or disability; reporting of child abuse or neglect; and, reporting of reactions to medications or problems with products.
- To a health oversight agency allowed by law such as: investigations, inspections and licensure actions.
- In response to a Court Order, Administrative Order or certain subpoenas.
- To a law enforcement official about a death we believe may be the result of criminal conduct; about criminal conduct at the health care facility; and in emergency circumstances, to report a crime, the location of a crime or victims, or the identity, description or location of the person who committed the crime.
- To a coroner or medical examiner. This may be necessary, for example, to identity a deceased person or determine the cause of death.
- To authorized federal officials for intelligence and other national security activities authorized by law.
- To authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
- OTHER USES OF YOUR MEDICAL INFORMATION: The following uses and disclosures of your medical information will be made only with your written permission (your written permission is referred to as an authorization): (i) most uses and disclosures of notes recorded by a health care provider who is a mental health professional documenting or analyzing the contents of conversation during a counseling session and that are separated from the rest of the medical record (if maintained by us); (ii) uses and disclosures for marketing purposes; and (iii) disclosures that constitute a sale of your medical information. In addition, other uses and disclosures of your medical information not covered by this Notice will be made only with your authorization. If you provide your permission to use or disclose medical information about you, you may revoke that permission in writing at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons indicated in your written authorization. You understand that we are unable to take back any disclosures that we made before we received your written notice revoking your authorization.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:
You have the following rights regarding medical information we maintain about you:
You have the right to inspect and obtain a copy of your medical information. This includes your medical and billing records but does not include psychotherapy notes. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request in certain circumstances. If you are denied access to your medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by Your Wellness Center will review your request and the denial. The person conducting the review will not be the same person who denied your request. We will comply with the outcome of the review.
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by the health care facility.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us.
- Is not part of the medical information kept by the health care facility.
- Is not part of the information which you would be permitted to inspect or copy; or,
- Is accurate and complete
You have the right to request an “accounting of disclosures “when commercial insurance, Medicare, or a third party is paying for your medical services. Your request must state a time period which may not be longer that one (1) year.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a restriction or limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.
We are not required to agree to your request for a restriction or limitation. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
In your request you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
If you paid in full and out of pocket at the time of your appointment and you request the information related to that specific date of service for which you paid in full not be shared with your health plan for payment or health care operations, we will honor your request.
You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work.
We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
You have a right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future provided that such changes are permitted by applicable law. We will post a copy of the current Notice at Your Wellness Center. The Notice will contain on the first page in the top right-hand corner, the effective date.
If you believe your privacy rights have been violated, you may file a complaint with Your Wellness Center. To file a complaint with Your Wellness Center, you must submit your complaint in writing to:
Your Wellness Center
William B. Lovett M.D.
7770 Cooper Road, Suite 8
Montgomery, Ohio 45242