Preventive Medicine & Weight Loss Center

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Notice of Privacy Policy

THIS NOTICE explains how your medical information may be used and disclosed, as well as how you can have access to it. PLEASE READ IT THOROUGHLY.

The following is Prevention Medical Center’ privacy policy as defined in the Health Insurance Portability and Accountability Act of 1996 and the rules established thereunder, commonly known as HIPAA. By law, HIPAA requires Covered Entity to safeguard your personal health information’s privacy and provide you with notice of the Covered Entity’s legal duties and privacy policies regarding your personal health information. The terms of this Privacy Notice must be followed by us by law.

Personal Medical Information

We collect your personal health information from various sources including treatment, payment, healthcare activities, and the enrollment process. This information includes any data, whether spoken, written, or recorded, created or received by healthcare entities such as physicians, hospitals, and health insurance companies or plans. The law provides strict protection for health information that can be used to identify you as an individual patient, such as your name, address, social security number, and other identifying details.

Personal Health Information Uses or Disclosures

We may not use or share your personal health information without your authorization in general. Furthermore, once we have gained your permission, we must use or disclose your personal health information in line with the terms of that authorization. The following are the legal circumstances in which we may use or disclose your personal health information.

Without your consent

We may use or disclose your personal health information without your consent in order to provide you with the services and treatment you require or request, or to collect payment for those services, and to conduct other connected health care activities otherwise permitted or required by law. In addition, we are entitled to disclose your personal health information within and among our personnel for the same purposes. Even with your agreement, we are still obligated to limit such uses or disclosures to the minimum amount of personal health information that is reasonably required to deliver those services or accomplish those activities.

Treatment activities include:

      •  health-care providers providing, coordinating, or managing healthcare and related services.
      •  consultation between health care professionals about a patient; or 
      •  referral of a patient to another health care provider for health care.

Payment activities include:

      •  billing and collection activities, as well as related data processing;
      •  actions by a health plan or insurer to obtain premiums or to determine or fulfill its responsibilities for coverage and provision of benefits under its health plan or insurance agreement, determinations of eligibility or coverage, adjudication or subrogation of health benefit claims; and
      •  medical necessity and appropriateness of care reviews.

Healthcare operations include:

      •  developing clinical guidelines;
      •  contacting patients with information about treatment alternatives or communications related to case management or care coordination;
      •  reviewing and training health care professionals; and
      •  underwriting and premium rating;
      •  medical review, legal services, and auditing functions, and
      •  general administrative activities such as customer service and data analysis.

Legally Required

We may use or disclose your personal health information to the extent allowed by law, and only to the extent that such use or disclosure complies with and is restricted to the relevant requirements of such law. Examples of situations in which we are compelled to disclose your personal health information include:

      •  Public health activities include preventing or controlling diseases or injuries, conducting public health surveillance or investigations, reporting adverse events related to food or dietary supplements, or product defects or problems to the Food and Drug Administration. Medical surveillance may also be conducted in the workplace to evaluate whether an individual has a work-related illness or injury to comply with Federal or state law.
      •  Disclosures may be made regarding victims of abuse, neglect, or domestic violence, including reporting to social service or protective services agencies.
      •  Health oversight activities include audits, civil, administrative, or criminal investigations, inspections, licensure or disciplinary actions, or civil, administrative, or criminal proceedings or actions, or other activities necessary for appropriate oversight of government benefit programs.
      •  Judicial and administrative proceedings may disclose personal health information in response to an order of a court or administrative tribunal, a warrant, subpoena, discovery request, or other lawful process.
      •  Law enforcement purposes may require disclosing personal health information for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person, reporting crimes in emergencies, or reporting a death.
      •  Disclosures about decedents may be made for purposes of cadaveric donation of organs, eyes, or tissue.
      •  Personal health information may be disclosed for research purposes under certain conditions.
      •  Personal health information may be disclosed to avert a serious threat to health or safety.
      •  Personal health information may be disclosed for military and veterans activities.
      •  National security and intelligence activities, protective services of the President and others, may also require the disclosure of personal health information.
      •  Medical suitability determinations by entities that are components of the Department of State may require the disclosure of personal health information.
      •  Correctional institutions and other law enforcement custodial situations may require the disclosure of personal health information.
      •  Personal health information may also be disclosed by covered entities that are government programs providing public benefits and for workers’ compensation purposes.

All Other Situations, With Your Specific Permission

We cannot use or disclose your personal health information without your explicit authorization, except as permitted or required by law as mentioned above. Additionally, we must follow the conditions of your authorization when using or disclosing your personal health information. You can withdraw your authorization for the use or disclosure of your personal health information at any time, except if we have already acted based on your authorization, or if you provided the authorization as a requirement to obtain insurance coverage, and another law allows the insurer to challenge a claim under the policy.

Miscellaneous Activities, Notice

We may contact you to remind you of your appointments or to provide information about treatment options or other health-related benefits and services that may be relevant to you. Additionally, we may contact you to request funds for the Covered Entity. If we are a group health plan or health insurance issuer, or an HMO in relation to a group health plan, we may disclose your personal health information to the sponsor of the plan.

Your Rights Regarding Your Personal Health Information

HIPAA grants you specific rights concerning your personal health information. The following is a concise summary of these rights and our obligations in upholding them.

Right to Request Restrictions on Use or Disclosure

You have the right to request restrictions on certain uses and disclosures of your personal health information. You may request restrictions on the following uses or disclosures:

      •  to carry out treatment, payment, or healthcare operations;
      •  disclosures to family members, relatives, or close personal friends of personal health information directly relevant to your care or payment related to your health care, or your location, general condition, or death;
      •  instances in which you are not present or your permission cannot be practicably obtained due to your incapacity or an emergency circumstance;
      •  permitting other persons to act on your behalf to pick up filled prescriptions, medical supplies, or other similar forms of personal health information; or
      •  disclosure to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.

While we are not required to agree to any requested restriction, if we agree to a restriction, we are bound not to use or disclose your personal healthcare information in violation of such restriction, except in certain emergency situations. We will not accept a request to restrict uses or disclosures that are otherwise required by law.

Right To Receive Confidential Communications

You have the right to receive your personal health information in a confidential manner. We may require written requests for such confidential communications and may ask for information on how payment will be handled and an alternate address or method of contact. However, we cannot require an explanation of why you are requesting confidential communications. We must accommodate reasonable requests from you to receive personal health information through alternative means or locations. If we are a healthcare plan, we must also accommodate reasonable requests for alternative communications if you state that disclosing the information could endanger you. We may require that such requests include a statement indicating that disclosure of the requested information could endanger you.

Right To Inspect And Copy Your Personal Health Information

Your designated record set contains medical and billing records, enrollment, payment, claims adjudication, and case or medical management records, as applicable. You have the right to access and obtain a copy of your personal health information in your designated record set, except for psychotherapy notes, information compiled for use in a legal proceeding, or health information that is prohibited by law. You may need to provide a written request for access. We will provide your personal health information in the form or format requested by you if readily producible, or in a readable hard copy form if not. Alternatively, we may provide a summary of the information or an explanation of the personal health information provided, if you agree to the fees and format in advance.

We will provide you with timely access to your personal health information and can arrange a convenient time and place for inspection or mailing a copy to you upon request. We may charge a reasonable fee for copying, postage, and preparing an explanation or summary, as agreed upon in advance. We reserve the right to deny access to certain personal health information as permitted by law, but we will make every effort to accommodate your request. If we deny your request, we will provide a written explanation of the legal basis for the denial and your rights to file a complaint. If we do not maintain the information you requested, we will inform you of where to direct your request.

Right To Amend Your Personal Health Information

You have the right to request that we amend your personal health information or a record about you contained in your designated record set, for as long as the designated record set is maintained by us. We have the right to deny your request for amendment if:

      •  we determine that the information or record that is the subject of the request was not created by us, unless you provide a reasonable basis to believe that the originator of the information is no longer available to act on the requested amendment,
      •  the information is not part of your designated record set maintained by us,
      •  the information is prohibited from inspection by law, or
      •  the information is accurate and complete. We may require that you submit written requests and provide a reason to support the requested amendment.

If we deny your request, we will provide you with a written denial stating the basis of the denial, your right to submit a written statement disagreeing with the denial, and a description of how you may file a complaint with us or the Secretary of the U.S. Department of Health and Human Services (“DHHS”). This denial will also include a notice that if you do not submit a statement of disagreement, you may request that we include your request for amendment and the denial with any future disclosures of your personal health information that is the subject of the requested amendment. Copies of all requests, denials, and statements of disagreement will be included in your designated record set. If we accept your request for amendment, we will make reasonable efforts to inform and provide the amendment within a reasonable time to persons identified by you as having received personal health information of yours prior to amendment and persons that we know have the personal health information that is the subject of the amendment and that may have relied, or could foreseeably rely, on such information to your detriment. All requests for amendment shall be sent to Prevention Medical Center.

Right To Receive An Accounting Of Disclosures Of Your Personal Health Information

You have the right to receive a written accounting of all disclosures of your personal health information that we have made immediately preceding the date on which the accounting is requested. You may request an accounting of disclosures for a period of less than six (6) years from the date of the request. Such disclosures will include the date of each disclosure, the name and, if known, the address of the entity or person who received the information, a brief description of the information disclosed, and a brief statement of the purpose and basis of the disclosure, or, in lieu of such statement, a copy of your written authorization or written request for disclosure pertaining to such information. We are not required to provide accountings of disclosures for the following purposes:

      •  treatment, payment, and healthcare operations,
      •  disclosures pursuant to your authorization,
      •  disclosures to you,
      •  for a facility directory or to persons involved in your care,
      •  for national security or intelligence purposes,
      •  to correctional institutions.

We reserve our right to temporarily suspend your right to receive an accounting of disclosures to health oversight agencies or law enforcement officials, as required by law. We will provide the first accounting to you in any twelve (12) month period without charge but will impose a reasonable, cost-based fee for responding to each subsequent request for accounting within that same twelve (12) month period. All requests for an accounting shall be sent to Prevention Medical Center.


You may file a complaint with us and with the Secretary of DHHS if you believe that your privacy rights have been violated. You may submit your complaint in writing by mail to our privacy officer, Madhu Panthi . A complaint must name the entity that is the subject of the complaint and describe the acts or omissions believed to be in violation of the applicable requirements of HIPAA or this Privacy Policy. A complaint must be received by us or filed with the Secretary of DHHS within 180 days of when you knew or should have known that the act or omission complained of occurred. You will not be retaliated against for filing any complaint.

Amendments to this Privacy Policy

We reserve the right to revise or amend this Privacy Policy at any time. These revisions or amendments may be made effective for all personal health information we maintain even if created or received prior to the effective date of the revision or amendment. We will provide you with notice of any revisions or amendments to this Privacy Policy, or changes in the law affecting this Privacy Notice, by mail or electronically within 60 days of the effective date of such revision, amendment, or change.

On-going Access to Privacy Policy

We will provide you with a copy of the most recent version of this Privacy Policy at any time upon your written request sent to Prevention Medical Center. For any other requests or for further information regarding the privacy of your personal health information, and for information regarding the filing of a complaint with us, please contact our privacy officer Madhu Panthi.