HIPAA Policy for MY Self Wellness Clinic / https://myselfwellness.com

Notice of HIPAA Privacy Practices for MY Self Wellness LLC

This Notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Introduction

MY Self Wellness LLC (referred to as “we,” “us,” or “our”) is committed to protecting your health information. This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations, and for other purposes that are permitted or required by law. It also describes your rights to access and control your PHI.

“Protected health information” is information about you, including demographic details, that can identify you and relates to your past, present, or future physical or mental health condition and related health care services.

We are required by law to maintain the privacy of your PHI and provide you with this Notice of our legal duties and privacy practices.

Uses and Disclosures of Protected Health Information

1. For Treatment, Payment, and Health Care Operations

Treatment

We will use and disclose your PHI to provide, coordinate, or manage your health care and related services. This includes sharing information with other healthcare providers involved in your care.

Payment

Your PHI will be used and disclosed as necessary to obtain payment for services provided by us or another provider. This includes activities to determine eligibility for health insurance benefits.

Health Care Operations

We may use or disclose your PHI as needed for the business operations of our practice, such as quality assessment, employee reviews, training of medical students, licensing, and other administrative purposes.

2. Other Permitted and Required Uses and Disclosures

We may use or disclose your PHI in the following situations without your authorization:

• Required by Law: Disclosures required by federal, state, or local law.
• Public Health: Reporting to public health authorities for purposes such as disease prevention and control.
• Communicable Diseases: Notifying individuals who may have been exposed to a communicable disease.
• Health Oversight Activities: Audits, investigations, and inspections by government agencies.
• Abuse, Neglect, or Domestic Violence: Reporting incidents to appropriate authorities.
• Legal Proceedings: Disclosures in response to court orders or subpoenas.
• Law Enforcement: Disclosures for law enforcement purposes when required by law.
• Coroners, Medical Examiners, and Funeral Directors: Assisting with identification and other duties.
• Organ Donation: For organ, eye, or tissue donation purposes.
• Research: When approved by an institutional review board that protects privacy.
• Threats to Health or Safety: To prevent or lessen a serious threat to public health or safety.
• Military and National Security: Disclosures for military or national security purposes.
• Workers’ Compensation: To comply with workers’ compensation laws.
• Correctional Institutions: If you are an inmate, for your health and the safety of others.
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3. Uses and Disclosures Requiring Your Authorization

Other uses and disclosures of your PHI will be made only with your written authorization unless otherwise permitted by law. You may revoke your authorization in writing at any time.

Your Rights Regarding Your Protected Health Information

1. Right to Inspect and Copy

You have the right to inspect and obtain a copy of your PHI, including medical and billing records, as long as we maintain the information.

2. Right to Request Restrictions

You may request that we restrict the use or disclosure of your PHI. While we are not required to agree to your request, we will comply if we do agree unless the information is needed for emergency treatment.

3. Right to Request Confidential Communications

You have the right to request that we communicate with you about medical matters in a certain way or at a specific location.

4. Right to Amend

If you believe that your PHI is incorrect or incomplete, you may request an amendment. We may deny your request in certain situations but will provide a written explanation.

5. Right to an Accounting of Disclosures

You have the right to request a list of certain disclosures of your PHI that we have made, except for those related to treatment, payment, or health care operations.

6. Right to Obtain a Paper Copy of This Notice

You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive it electronically.

Complaints

You may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated. We will not retaliate against you for filing a complaint.

How to Contact Us

If you have questions or concerns about our privacy practices or need further information, please contact our Privacy Officer at:

Contact Information: info@myselfwellness.com or by calling us at (239)908-9958

Changes to This Notice

We reserve the right to change the terms of this Notice at any time. The new Notice will be effective for all PHI that we maintain at that time. We will post a copy of the current Notice on our website and will provide it to you upon request.

Last Updated: September 26, 2024