Notice of Privacy Practices
To our patients:
This notice describes how health information about you, as a
patient of this practice, may be used and disclosed, and how
you can get access to your health information. This notice is
required by the Privacy Regulations created as a result of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA).
Our commitment to your privacy:
Our office is dedicated to maintaining the privacy of your
health information. We are also required by Federal law to
maintain the confidentiality of your health information.
Although these laws are complicated, all medical providers are
required to provide you with the following important
The HIPAA law permits the use and disclosure of
personally-identifiable health information as needed for
diagnosis, treatment or billing of health care services,
provided that any such disclosure must be limited to the
minimum necessary information to accomplish these purposes,
and only to properly qualified persons. Special safeguards
must be maintained to minimize any chance of inadvertent
disclosure of personally-identifiable health information to
unauthorized persons, particularly of especially sensitive
information such as psychological or HIV status. We are
committed to maintaining the security and privacy of all
information (including billing information) contained in our
medical records, including electronic records and data
Use and disclosure of your health information in certain
The following additional circumstances may also require us to
use or disclose your health information:
- To public health authorities and health oversight
agencies that are authorized by law to collect such
- Lawsuits and similar proceedings in response to a court
or administrative order.
- If required to do so by a law enforcement official.
- When necessary to reduce or prevent a serious threat to
your health and safety or the health and safety of another
individual or the public. We will only make disclosures to a
person or organization able to help prevent the threat.
- If you are a member of U.S. or foreign military forces
(including veterans) and if required by the appropriate
- To federal officials for intelligence and national
security activities authorized by law.
- To correctional institutions or law enforcement
officials if you are an inmate or under the custody of a law
- For Workers Compensation and similar programs.
- In order to avert a serious threat to the health and
safety of you or any other person pursuant to applicable
Your rights regarding your health information:
- Communications. You can request that our practice
communicate with you about your health and related issues in
a particular manner or at a certain location. For instance,
you may ask that we contact you at home, rather than work.
We will accommodate reasonable requests.
- You can request a restriction in our use or disclosure
of your health information for treatment, payment, or health
care operations. Additionally, you have the right to request
that we restrict our disclosure of your health information
to only certain individuals involved in your care or the
payment for your care, such as family members and friends as
provided by 45 CFR §164.522. We are not required to agree to
your request; however, if we do agree, we are bound by our
agreement except when otherwise required by law, in
emergencies, or when the information is necessary to treat
- You have the right to inspect and obtain a copy of the
health information that may be used to make decisions about
you, including patient medical records and billing records,
but not including psychotherapy notes as outlined in 45 CFR
§164.524. You must submit your request in writing to Fresh
- You may ask to amend your health information if you
believe it is incorrect or incomplete, and as long as the
information is kept by or for our office as provided for in
45 CFR §164.526. To request an amendment, your request must
be made in writing and submitted to Fresh Vitality. You must
provide a reason that supports your request for amendment.
- Right to a copy of this notice. You are entitled to
receive a copy of this Notice of Privacy Practices. You may
ask for a copy of this Notice at any time. To obtain an
additional copy of this notice, contact Grace Ariss.
- Accounting of disclosures. You have a right to receive
an accounting of all disclosures made of your health
information as provided by 45 CFR §164.528.
- Right to file a complaint. If you believe your privacy
rights have been violated, you may file a complaint with our
office or with the Secretary of the US Department of Health
and Human Services. To file a complaint with our office,
contact Grace Ariss. All complaints must be submitted in
writing. You will not be penalized for filing a complaint.
- Right to provide an authorization for other uses and
disclosures. Our office will obtain your written
authorization for uses and disclosures that are not
identified by this notice or permitted by applicable law.
If you have any questions regarding this notice or our
health information privacy policies, please contact Grace