THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
Healthier Life Medicine PLLC (“Healthier Life”) is
required by the Health Insurance Portability and Accountability
Act of 1996, as amended (“HIPAA”), to maintain the
privacy and security of your protected health information (PHI)
and to provide you with a notice of Healthier Life’s legal
duties and privacy practices with respect to protected health
information (PHI) that Healthier Life may collect and maintain
about you. This protection extends to any PHI whether in oral,
written, or electronic format. This Notice of Health Information
Privacy Practices (“Notice”) describes how we may use and
disclose your protected health information (PHI) to carry out
treatment, payment or health care operations and for other
specified purposes that are permitted or required by law. The
Notice also describes your rights with respect to your protected
health information (“PHI”) when in the hands of Healthier
Life and its business associates, which are vendors that may
assist us in providing services to you. PHI is any information
that identifies you or may be used to identify you (e.g., basic
demographic information); that is created or received by a
health care provider, health plan, employer or health care
clearinghouse; and that relates to your past, present or future
physical or mental health or condition and related health care
services, or provision of or payment for health care.
We are required by law to abide by the terms of this Notice. We
will not use or disclose your PHI without your prior written
authorization, except as permitted or required by law and
described in this Notice. Please note that if other federal,
state, or local laws, rules or regulations restrict or limit the
use and disclosure of your PHI in ways that are permitted under
this Notice, Healthier Life will only use or disclose your PHI
in compliance with the stricter law, rule or regulation. We
strongly urge you to read this Notice carefully and thoroughly
so that you will understand both our commitment to protecting
the privacy of you PHI and how you can participate in the
protection of this information.
What PHI We Collect
We attempt to collect the minimal amount of information
necessary for Healthier Life to provide our services to you and
to obtain payment for those services. This may include your
name, address, telephone number, social security number, date of
birth, medical history, diagnosis, treatment, provider
identification, financial responsibility, health insurance
coverage (including group numbers and member identification
numbers), and payment information.
How We May Use and Disclose Protected Health Information About
You WITHOUT YOUR CONSENT
With the exception of information that may qualify for special
protection under state and/or federal law, the following
categories describe different ways that we use and disclose your
PHI. Not every possible use or disclosure in a category is
listed below. However, all of the ways in which we are permitted
to use and disclose PHI will fall within one of the categories
below. Also, Healthier Life must limit its uses, disclosures, or
requests for your PHI to the “minimum necessary” to accomplish
the intended purpose of such use, disclosure, or request, except
as permitted by law. Please note that, for purposes of this
Notice, any references to “we” or “Healthier Life” include all
business associates we may engage.
Treatment: We may use or disclose your PHI to provide and
coordinate the treatment and services you receive. For example,
we may use your PHI to perform diagnostic tests, or provide your
test results to your physician or other authorized health care
provider. We may also disclose your PHI to another testing
laboratory if we are unable to perform the testing ourselves and
as such need to refer your specimen to that laboratory to
perform the requested testing.
Payment: We may use and disclose your PHI to others for
purposes of receiving payment for treatment and services that
you receive. For example, we will submit a claim to you, your
health care provider, or your health plan/insurer that includes
information that identifies you and the type of services we
performed for you.
Health Care Operations:
Healthier Life may use or disclose your PHI in order to support
the health care operations of its business and monitor the
quality of the care we provide. For example, we may use
information in your health record to evaluate the services we
provide or to train Healthier Life’s staff. In addition, “health
care operations” include conducting quality assessment and
improvement activities, including outcomes evaluation and
development of clinical guidelines; patient safety activities;
population-based activities relating to protocol development,
case management and care coordination, contacting of health care
providers and patients with information about treatment
alternatives, and related functions that do not include
treatment; submitting claims for stop-loss coverage; conducting
or arranging for medical review, legal services, and audit
services; wellness and disease management programs; and business
planning, development, management and general administration of
the clinical lab.
To Communicate with Individuals Involved in Your Care or
Payment for Your Care:
We may disclose to a family member, other relative, close
personal friend or any other person you identify, PHI that is
directly relevant to that person's involvement in your care or
payment related to your care. We may disclose the relevant PHI
to these persons with your consent or if we can reasonably infer
from the circumstances that you do not object to the disclosure.
If you are incapacitated, we can make the disclosure if, in the
exercise of professional judgment, we believe the disclosure is
in your best interests. To the extent permitted under federal
and state law, we may disclose PHI of minors to their parents or
legal guardians.
Business Associates:
There are some services provided by Healthier Life through
contracts with business associates (e.g., billing services), and
we may disclose your PHI to Healthier Life’s business associate
so that they can perform the job we have asked them to do. To
protect your information, however, we require the business
associate to enter into a Business Associate Agreement, which
specifies the ways in which the business associate may use and
disclose your PHI and must appropriately safeguard your
information.
Government Agencies:
We may disclose to certain government agencies (e.g., FDA, CMS,
OIG, CLIA accreditation organizations, etc.), or persons under
the jurisdiction of such agencies, PHI relative to adverse
events with respect to products and/or services we provide, or
information to enable product recalls, repairs, or replacements.
Worker’s Compensation:
We may disclose your PHI to the extent authorized by and to the
extent necessary to comply with laws relating to worker’s
compensation or other similar programs established by law. These
programs provide benefits for work-related injuries or illness
without regard to fault.
Public Health:
As permitted by law, we may disclose your PHI to public health
or legal authorities charged with preventing or controlling
disease, injury, or disability; to report the abuse or neglect
of children, elders, dependent adults, or others; or to a person
who may have been exposed to a communicable disease or otherwise
be at risk of contracting of spreading the disease or condition.
Law Enforcement or As Otherwise Required by Law:
We may disclose your PHI when required to do so by federal,
state, or local law or for law enforcement purposes as permitted
by law, such as in response to a valid subpoena or court order
and to assist in locating suspects, fugitives or witnesses, or
victims of crime.
Health Oversight Activities:
We may disclose your PHI to an oversight agency for activities
authorized by law. These oversight activities may include
audits, investigations, and inspections necessary for licensure
and for the government to monitor the health care system,
government programs, and compliance with laws.
Judicial and Administrative Proceedings:
We may disclose your PHI in response to a court or
administrative order. We may also disclose PHI in response to a
subpoena, discovery request, or other lawful process, but only
if efforts have been made, either by the requesting party, or us
to tell you about the request or to obtain an order protecting
the information requested.
Research:
Under certain circumstances, we may use and disclose your PHI
for research purposes. In many cases, we will ask for your
written authorization before using or sharing your PHI with
others in order to conduct research. However, under some
circumstances, we may use and disclose your PHI without your
written authorization if an institutional review board or
privacy board, applying specific criteria, determines that the
particular research poses no more than minimal risk to your
privacy. We may also use or disclose your PHI without your
written authorization to determine whether you might qualify to
participate in a research project or to prepare a future
research project as long as your PHI is not removed from
Healthier Life premises. We may also use or disclose a copy of
your PHI that has had your name and other information that can
readily identify you removed, if the recipient of the
information enters into a legal contract agreeing to protect the
information from unauthorized access. Under certain
circumstances, we may use and disclose your PHI for research
purposes, as well as PHI of deceased persons if the research
satisfies certain criteria.
To Avert a Serious Threat to Health or Safety: We may use
and disclose your PHI, if in good faith, we believe the use or
disclosure: (i) is necessary to prevent or lessen a serious and
imminent threat to your health and safety or the health and
safety of the public or another person, and is to a person or
persons reasonably able to prevent or lessen the threat,
including the target of the threat; or (ii) is necessary for law
enforcement authorities to identify or apprehend an individual
based on statements made by the individual admitting to
participation in a violent crime, or where the individual has
escaped from a correctional institution or from lawful custody,
or (iii)is necessary for national security, intelligence, or
protective services activities.
Military and Veterans: If you are a member of the armed
forces, we may use and disclose PHI about you for activities
deemed necessary by appropriate military command authorities to
assure the proper execution of a military mission.
Treatment Alternatives and Health-Related Benefits and
Services:
We may use and disclose your PHI to tell you about possible
treatment options or alternatives and health-related benefits
and services that may be of interest to you.
Sale or Merger: In the event of a sale or merger with
another organization, your PHI will become the property of the
new owner.
Use and Disclosure of PHI (WITH YOUR CONSENT)
Healthier Life will obtain your written authorization before
using or disclosing your PHI for purposes other than those
provided for in this Notice (or as otherwise permitted or
required by law). Examples include any uses and disclosures of
your PHI for marketing purposes, and disclosures that constitute
a sale of PHI require your written authorization. You may revoke
this authorization in writing at any time. Upon receipt of the
written revocation, we will stop using or disclosing your PHI,
except to the extent that we have already taken action in
reliance on the authorization.
Your Rights Regarding Your Health Information/PHI
Obtain a Paper Copy of the Notice upon request. You may request
a paper copy of Healthier Life’s current Notice at any time from
the Healthier Life’s Privacy Office. Even if you have agreed to
receive the Notice electronically, you are still entitled to a
paper copy. All requests for a paper copy of the Notice must be
submitted in writing or electronically to Healthier Life at the
contact information listed below.
Right To Access and Obtain A Copy Of PHI. You (or your
designated representative) have the right to access and receive
a copy of your PHI that may be used to make decisions about your
care or payment for your care. If we maintain the information
you have requested in an electronic format you may ask for it to
be provided to you electronically, and also ask us to
electronically send copies to another person. To exercise this
right, you must send a written request to Healthier Life. We may
deny your request to inspect and copy in certain limited
circumstances. If you are denied access to your PHI, you will
receive a written denial and information regarding how your
denial may be reviewed.
Request A Restriction on Certain Uses and Disclosures Of
PHI.
You have the right to request additional restrictions on how we
use or disclose your PHI for treatment, payment, health care
operations, and communications to those involved in your care by
sending a written request to Healthier Life’s Privacy Office. We
will consider your request but are not required to agree to it
unless the requested restriction involves a disclosure that is
not required by law to a health plan for payment or health care
operations purposes and not for treatment, and you, or someone
on your behalf, have paid for the service in full out of pocket.
If we agree to a restriction on other types of disclosures, we
will abide by them, except in emergency situations when the
disclosure is for purposed of treatment. All requests for
restrictions on the use or disclosure of your PHI must be
submitted in writing to Healthier Life at the contact
information listed below. We retain the right to terminate an
agreed-to restriction if we believe such termination is
appropriate. In the event we have terminated an agreed-to
restriction, we will notify you of such termination.
Request An Amendment Of PHI. You have a right to request
that PHI that we maintain about you be amended or corrected. To
request an amendment, you must send a written request to
Healthier Life at the contact information listed below. You must
include a reason that supports your request. We may process your
request in accordance with our policy, but original information
will not be removed. In certain cases, we may deny your request
for an amendment for various reasons, including if we did not
create the information or if we believe the current information
is accurate and complete. You will be notified in writing if
your request is denied. If you request is denied, you have the
right to submit a written statement disagreeing with the denial,
which, at your request, may be appended or linked to the PHI in
question. All requests for an amendment of your PHI must be
submitted in writing to Healthier Life.
Receive an Accounting of Disclosures Of PHI. You have the
right to receive an accounting of the disclosures Healthier Life
or its business associates have made of your PHI for most
purposes other than treatment, payment, health care operations,
and certain other limited purposes. The right to receive an
accounting of disclosures is subject to certain exceptions,
restrictions, and limitations. To request an accounting, you
must submit your request in writing to Healthier Life’ Privacy
Office. Your request must specify the time period for which you
would like an accounting, but this time period may not be longer
than six years prior to your request. All requests for an
accounting of the disclosures of your PHI must be submitted in
writing to Healthier Life at the contact information listed
below.
Request Confidential Communications of PHI By Alternative
Means or At Alternative Locations.
You have a right to request to receive communications of PHI by
alternate means or at alternate locations. For instance, you may
request that we contact you about medical matters only in
writing or at a different residence or post office box. To
request confidential communication of your PHI, you must submit
a request in writing to Healthier Life’s Privacy Office. Your
request must state how or where you would like to be contacted.
All requests for communication of PHI by alternative means or at
alternative locations must be submitted in writing to Healthier
Life.
Right to Receive Notification in the Event of a Breach.
You have a right to receive notification if there is a breach of
your unsecured PHI, except in those instances where we determine
that there is a low probability that the PHI has been
compromised. After learning of such a breach, we must provide
notice to you without unreasonable delay and in no event later
than sixty (60) calendar days after Healthier Life’s discovery
of the breach, unless a law enforcement official requires us to
delay the breach notification.
Security of your PHI
Access to PHI is restricted to only those employees, agents, or
contractors of Healthier Life who require it to provide services
to you or your healthcare provider(s) or obtain payment from
those financially responsible for payment. Healthier Life
maintains physical, technical, and procedural safeguards
protecting PHI against unauthorized use and disclosure.
Healthier Life’ Privacy Office is responsible for overseeing the
proper and effective implementation of all required rules and
regulations, as well as policies and procedures concerning the
use and disclosure or PHI, including ensuring proper
educating/training, investigating all issues, complaints and
concerns, audit and monitoring compliance by Healthier Life and
its employees, agents and contractors. Please note that any
e-mail or text message communication you initiate with Healthier
Life regarding your PHI is not secured in accordance with the
HIPAA security standards. As a general rule, Healthier Life will
not communicate with you through e-mail or text message unless
the e-mail or text message can be properly encrypted or with
your permission/consent.
Complaints/Objections
To file a complaint with Healthier Life, you must submit a
written complaint to Healthier Life’s Privacy Office at the
address listed below. Any submission must be marked
“Confidential,” and should include your name, address, and
telephone number where we can contact you (unless you chose to
remain anonymous) and a brief description of your concern,
issue, or complaint. Filing a complaint will not affect your
rights to your personal data or services provided by Healthier
Life.
How to Contact Us
If you would like to exercise your rights or would like
additional information about Healthier Life’s privacy practices,
you may contact: By Mail: Healthier Life Medicine PLLC By Email:
support@healthier.clinic By Telephone: (855) 470-0837 If you
believe your privacy rights have been violated, you may also
file a complaint with Healthier Life’s Privacy Office or with
the applicable agency listed below: By Mail: Office for Civil
Rights The U.S. Department of Health and Human Services 200
Independence Avenue, S.W. Washington, D.C. 20201 By Telephone:
1-877-696-6775 Or Visiting:
www.hhs.gov/ocr/privacy/hipaa/complaints/
Changes to this Notice
Healthier Life reserves the right to change its practices and
the terms of this Notice as, and to the extent permitted by law,
to make the new Notice effective for all PHI and personal data
we maintain without prior notice to you. The new Notice will be
available upon request and on our website.
Obtaining a Copy of this Notice
You are permitted to print or make a copy of this Notice for
your records. If you do not have the ability to print or make a
copy, you may request one by contacting the Healthier Life’s
Privacy Office at the address listed above.
Effective Date
This Notice was revised and became effective as of 10/1/2021.
I acknowledge receiving the Notice of Privacy Practices from
Healthier Life Medicine PLLC.