with Adventure Bound Fitness & Nutrition, LLC
Notice of Privacy Practices
Effective Date: March 1, 2017
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. This notice describes our practices and that of any health care professional authorized to enter information into your medical record. Please review it carefully.
We are committed to protecting medical information about you. We create a record of your services to provide you with quality care and to comply with legal requirements. This notice will tell you how we may use and disclose your medical information. We are required by law to: (A) make sure that medical information that identifies you is kept private; (B) give you this notice of our legal duties and privacy practices; (C) abide by the terms of the notice currently in effect.
The following categories describe different ways that we may use and disclose your medical information without written authorization.
- For Treatment: To the workforce who are involved in taking care of you. For example, a physician may need to know information about your diet because it is related to his/her treatment, or perhaps signs and symptoms of diabetes are uncovered and you should have further testing.
- For Payment: To insurance companies or third-party payors or individuals responsible for payment. For example, we may need to give your health plan information about services received so your health plan may be billed. We may also tell your health plan about services you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
- For Health Care Operations: To run the organization and make sure that all of our patients receive quality care. The workforce may use medical information to review our services and evaluate our performance. It may also be used for review and training purposes.
- Notifications: We may use and disclose medical information to notify you about Appointment Reminders, Treatment Options and Alternatives, Health-Related Benefits and Services. There will be no fund-raising activities.
- As Required By Law: To Federal, state or local law enforcement as required by law, and to public health officials as requested by law. In addition, if you become involved in a claim or law suit we may be required by law to release information.
- Individuals Involved in Your Care or Payment for Your Care: To family or friends involved in your care or who help pay for your health care, or to disaster relief organizations who may need to contact your family about your condition.
You have the following rights regarding medical information we maintain about you:
*Right to Inspect and Copy:
- Medical information that may be used to make decisions about your care.
- You must submit your request in writing to Kate Campbell. 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 to inspect and copy in certain circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the organization will review your request and the denial. We will comply with the outcome of the review.
*Right to Amend:
- 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.
- To request an amendment, your request must be made in writing and submitted to Kate Campbell. In addition, you must provide a reason that supports your request.
- 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:(a) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; (b) is not part of the medical information kept; (c) is not part of the information that you would be permitted to inspect and copy; or (d) is accurate and complete.
*Right to an Accounting of Disclosures: This is a list of the disclosures we made of medical information about you. To request this list, you must submit your request in writing to Kate Campebll. Your request must state a time period which may not be longer than six years and may not include dates before March 1, 2018. The first list you request within a 12 month period will be free.
*Right to Request Restrictions: On the medical information we use or disclose about you for treatment, payment or health care operations. To request restrictions, you must make your request in writing to the Kate Campbell. In your request, you must tell us (A) what information you want to limit; (B) whether you want to limit our use, disclosure or both; and (C) to whom you want the limits to apply, for example, disclosures to your spouse. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
*Right to Request Confidential Communications: For example, you can ask us to only contact you at home, not at your place of work. To request confidential communications, you must make your request in writing to Kate Campbell. Your request must specify how or where you wish to be contacted.
*Right to a paper copy of this notice: You may print this notice at any time, for your records.
If you believe your privacy rights have been violated, you may contact Kate Campbell. You will not be penalized for filing a complaint. Or you may file a complaint with the Secretary of the Region V, Office for Civil Rights, U.S. Department of Health and Human Services. All complaints must be submitted in writing.
Other uses and disclosures of medical information not covered by this notice and the laws that apply, will be made only with your written authorization. You may revoke your authorization in writing at any time. However, you must understand that we are unable to take back any disclosures we have already made with your authorization.
We reserve the right to change this notice. Any changes will be effective for medical information we already have as well as any information we receive in the future. We will post a copy of the current notice.