Your Information. Your Rights. Our Responsibilities.

This notice describes how medical information about you may be used and disclosed and how you can access this information.

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Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you:

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➤ Get an electronic or paper copy of your medical record

• You can ask to see or receive an electronic or paper copy of your medical records and other health information we maintain.

• We will provide a copy or summary usually within 30 days of your request. A reasonable, cost-based fee may apply.

➤ Ask us to correct your medical record

• You can request corrections to your medical information if you believe it's incorrect or incomplete.

• We may decline your request but will provide an explanation in writing within 60 days.

➤ Request confidential communications

• You may ask us to contact you in a specific way (e.g., at home, work) or to send mail to a different address.

• We will accommodate all reasonable requests.

➤ Ask us to limit what we use or share

• You can ask us not to use or share certain health information for treatment, payment, or operations.

• We are not required to agree, but we will comply if the request does not interfere with your care.

• If you pay out-of-pocket in full for a service, you can request that we not share that information with your health insurer. We will honor that request unless required by law.

➤ Get a list of those with whom we’ve shared information

• You can request an accounting of disclosures of your health information going back six years.

• One free report per year is allowed; additional requests may result in a reasonable, cost-based fee.

➤ Get a copy of this privacy notice

• You can request a paper copy of this notice at any time, even if you agreed to receive it electronically.

➤ Choose someone to act for you

• If you have given someone medical power of attorney or have a legal guardian, they may exercise your rights and make decisions on your behalf, once their authority is verified.

➤ File a complaint if you feel your rights are violated

• You may file a complaint with us directly using the contact information below.

• You may also file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, by calling 1-877-696-6775 or visiting www.hhs.gov/ocr/privacy/hipaa/complaints.

• We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you have the right to decide what we share. You can let us know if you have a preference for:

• Sharing information with family, friends, or others involved in your care

• Including your information in disaster relief efforts

• Including your information in a facility directory (if applicable)

If you're unable to communicate your preferences (e.g., unconscious), we may share information if we believe it is in your best interest.

In these cases, we never share your information unless you give us written permission:

• For marketing purposes

• The sale of your health information

• Most uses of psychotherapy notes

We may contact you for fundraising purposes, but you can opt out of receiving these communications.

Our Uses and Disclosures

We typically use or share your health information in the following ways:

➤ Treat you

• We share your health information with other healthcare professionals involved in your care.
  Example: A doctor treating you asks another doctor about your condition.

➤ Run our organization

• We use your information to operate our practice and improve your care.
  Example: We analyze your treatment progress to improve future services.

➤ Bill for your services

• We use your health information to bill and receive payment from health plans or other entities.
  Example: We provide details to your insurance so they will pay for your treatment.

Other Ways We May Use or Share Your Information

We are permitted or required by law to share your information in other ways that benefit the public, such as public health or research.

➤ Help with public health and safety issues

• We may share your information for:

  • Preventing disease

  • Reporting product recalls

  • Reporting adverse medication reactions

  • Reporting abuse, neglect, or domestic violence

  • Preventing or reducing serious health or safety threats

➤ Conduct research

• We may use or share your information for health research under certain conditions.

➤ Comply with the law

• We will share information as required by federal or state law, including with HHS to verify HIPAA compliance.

➤ Respond to organ and tissue donation requests

• We may share information with organizations that manage organ or tissue donation.

➤ Work with a coroner or medical examiner

• We may share information in the event of a death.

➤ Address workers’ compensation, law enforcement, and government requests

We may use or share your information:

• For workers' compensation claims

• For law enforcement purposes

• With health oversight agencies

• For special government functions such as national security

➤ Respond to lawsuits and legal actions

• We may share your health information in response to a court or administrative order or subpoena.

Our Responsibilities

• We are required by law to protect the privacy and security of your health information.

• We will notify you promptly if a breach occurs that may have compromised your information.

• We must follow the terms of this notice and provide you a copy upon request.

• We will not use or share your information outside what is described here unless you give written permission—and you can revoke that permission at any time.

For more information, visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

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Changes to This Notice

We may change the terms of this notice at any time. Any changes will apply to all medical information we currently have about you and will be available upon request, in our office, and on our website.

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This Notice Applies To:

Destin Weight Loss and Wellness
3997 Commons Drive West, Suite L
Destin, FL 32541
Phone: (850) 226-0946
Email: Info@destinweightlossandwellness.com
Website: www.destinweightlossandwellness.com