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HIPPA Customer Notification
NOTICE OF PRIVACY PRACTICES
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.
Nutrition For Wellness (hereinafter called “the Company”) is committed to protecting the privacy of your Protected Health Information (“PHI”) that we receive in accordance with federal and state privacy laws, as well as the Company’s own privacy policies, practices and procedures. The Company is required by law to provide individuals with notice of it’s legal duties and privacy practices with respect to PHI. PHI is information about you, including basic demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices (“Notice”) describes how the Company may use and disclose PHI to carry out treatment, payment or health care operations and for other specified purposes that are permitted or required by law. This Notice also describes your rights with respect to PHI about you.
We are required to follow the terms of this Notice. We will not use or disclose PHI about you without your written authorization, except as described in this Notice.
2. Changes to this Notice
We reserve the right to revise, change or amend our practices and this Notice and to make the new Notice effective for all PHI that we already have about you, as well as any of your PHI that we may receive, create or maintain in the future. You may request a paper copy of our current Notice from us at any time.
3. Your Health Information Rights
You have the following rights with respect to PHI about you:
Obtain a paper copy of the Notice upon request. You may request a copy of the Notice at any time. To request a paper copy, send a written request to the Company’s Privacy Officer addressed as follows: Nutrition For Wellness, Attn: Privacy Officer, P.O. Box 1133, Mount Airy, MD 21771, or a different address that the Company may designate at a later date (the Notice Address).
Request a restriction on certain uses and disclosures of PHI. You have the right to request additional restrictions on our use or disclosure of PHI about you by sending a written request to the Company’s Privacy Officer addressed to the Notice Address. Please clearly and concisely identify: (i) the information you wish to be restricted; (ii) how you want the information restricted; and (iii) to whom you want the limits to apply. We are not required to agree to those restrictions. However, if we do agree, we will comply with the restrictions, except to the extent when otherwise required by law, in emergencies, or when the information is necessary to treat you.
Inspect and obtain a copy of PHI. You have the right to access and copy PHI about you that may be used to make decisions about you – a “designated record set” – for as long as Nutrition For Wellness maintains the PHI. To inspect or copy PHI about you, you must send a written request to the Company’s Privacy Officer at the Notice Address that is provided in section 7 of this Notice. We may charge you a fee for the costs associated with copying and mailing your request. We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to PHI about you, you may request that the denial be reviewed by sending a written request to the Company’s Privacy Officer at the Notice Address.
Request an amendment of PHI. If you feel that PHI we maintain about you is incomplete or incorrect, you may request that we amend it. You may request an amendment for as long as we maintain the PHI. To request an amendment, you must send a written request to the Company’s Privacy Officer at the Notice Address. You must include a reason that supports your request. In certain cases, we may deny your request for amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with the decision by sending your statement to the Privacy Officer at the Notice Address, and we may give a rebuttal to your statement.
Receive an accounting of disclosures of PHI. You have the right to receive an accounting of the disclosures we have made of PHI about you after April 14, 2003 for certain purposes. The accounting will exclude certain uses and disclosures, such as those made for treatment, payment or healthcare operations, disclosures made directly to you, disclosures you authorize, and disclosures to friends or family members involved in your care. The right to receive an accounting is subject to certain other exceptions, restrictions and limitations. To request an accounting, you must submit a request in writing to the Company’s Privacy Officer at the Notice Address. Your request must specify the time period, but may not be longer than six years. The first accounting request within a 12 month period will be provided free of charge, but you may be charged for the cost of providing additional accountings. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time.
Confidential communications. You have the right to request that we communicate with you about your health and related issues in a particular manner, or at a certain location. For instance, you may request that we contact you about medical matters only in writing, rather than by telephone, or at work, rather than at home. To request confidential communication of PHI about you, you must submit a request in writing to the Company’s Privacy Officer at the Notice Address. Your request must state how or where you would like to be contacted, but you do not need to provide a reason for your request. We will accommodate all reasonable requests.
4. How We May Use and Disclose PHI
The following are descriptions of ways we will, or may, use and disclose your PHI. Please note that each particular use or disclosure is not listed below. However, the different ways that we are permitted to use and disclose your PHI fall within one of the categories listed in this section.
We will use PHI for treatment.
We will use PHI for payment.
We will use PHI for health care operations.
Business associates: We may share your PHI with certain business associates that perform services for us through contracts that we have with them.
Communication with individuals involved in your care or payment for your care.
Health-related communications: We may use or disclose your PHI in order to communicate with you, by telephone or otherwise, about a product or service related to your treatment, or to help coordinate or manage your care, or to direct or recommend treatment alternatives, therapies, providers, settings of care, or other health-related benefits and services that may be of interest to you.
Food and Drug Administration (FDA): We may disclose to the FDA, or persons under the jurisdiction of the FDA, PHI related to adverse events with respect to drugs, foods, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs or replacements.
Worker’s Compensations: We may disclose PHI about you as authorized by, and as necessary to comply with, laws relating to worker’s compensation or similar programs established by law.
Public health: As required by law, we may disclose PHI about you to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Law enforcement: We may disclose PHI about you for law enforcement purposes as required by law or in response to a valid subpoena or other legal process.
As required by law: We must disclose PHI about you when required to do so by law.
Health oversight activities: We may disclose PHI about you to an oversight agency for activities authorized by law. These oversight activities can include, for example, audits, investigations, and inspections, as necessary for our licensure and for the government to monitor government programs, compliance with civil rights laws, and the health care system in general.
Judicial and administrative proceedings: If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the requested PHI.
Coroners, medical examiners, and funeral directors: We may release PHI about you to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also disclose PHI to funeral directors consistent with applicable law to carry out their duties.
Notification: We may use or disclose PHI about you to notify, or assist in notifying, a family member, personal representative, or another person responsible for your care, or your location and your general condition.
Correctional institution: If you are or become an inmate or a correctional institution, we may disclose PHI to the institution or law enforcement officials when necessary to provide health services to you, for the safety and security of the institution, and/or to protect your health and safety or the health and safety of others.
To avert a serious threat to health or safety: We may use and disclose PHI about you when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of the public or another person.
Military and veterans: If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release PHI about you to foreign military personnel to the appropriate military authority.
National security and intelligence activities: We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective services for the President and others: We may disclose PHI about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or to conduct special investigations.
Victims of abuse, neglect or domestic violence: We may disclose PHI about you to a government authority, such as a social service or protective services agency, if we reasonably believe you are a victim of abuse, neglect or domestic violence. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else, and if the law enforcement or public official that is to receive the report represents that it is necessary and will not be used against you.
5. Authorization for Other Uses and Disclosures of PHI
We will obtain your written authorization before using or disclosing PHI about you for purposes other than those provided for above or as otherwise permitted or required by law. You may revoke an authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing PHI about you, except to the extent that we have already taken action in reliance on the authorization. However, please note that we may be required by applicable law to retain certain PHI about you, particularly regarding the provision of health care services and products.
6. For More Information or to Report a Problem
If you have questions or would like additional information about the Nutrition For Wellness privacy practices, you may contact the Company’s Privacy Officer at the Notice Address. If you believe your privacy rights have been violated, you can file a written complaint with the Company’s Privacy Officer at the Notice Address or with the Secretary of the federal Department of Health and Human Services. There will be no retaliation for filing a complaint.
7. Notice Address
Please send all correspondence, requests, questions and complaints related to the permitted or required uses and disclose of your PHI by the Company and your rights with respect to your PHI to the following address (Notice Address) in written form:
Nutrition For Wellness
Attn: Privacy Officer
P.O. Box 1833, Mount Airy, MD 21771
This notice is effective as of April 14, 2003.
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