HIPAA 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.
Lipedema Warrior Clinic ("Clinic," "we," "us") is required by law to maintain the privacy of your Protected Health Information ("PHI"), to provide you with this Notice of our legal duties and privacy practices, to notify you following a breach of unsecured PHI, and to abide by the terms of the Notice currently in effect.
Our Pledge Regarding Your Health Information
PHI is information that can be used to identify you and that relates to your past, present, or future physical or mental health, the provision of healthcare to you, or payment for that care. We are committed to protecting your PHI.
How We May Use and Disclose Your PHI
For Treatment
We use and disclose PHI to provide care—for example, by consulting with other providers, ordering laboratory tests, prescribing medications, coordinating with compounding pharmacies, and sharing information with members of your care team.
For Payment
We use and disclose PHI to bill and obtain payment for services—for example, by submitting claims to insurance, verifying coverage, or working with payment processors.
For Health Care Operations
We use and disclose PHI for activities necessary to operate the Clinic, including quality improvement, training, credentialing, audits, legal services, and business management.
Other Uses and Disclosures That Do Not Require Your Authorization
• Appointment reminders, treatment alternatives, and health-related benefits and services.
• To family members, friends, or others involved in your care, with your agreement or where you do not object, to the extent relevant to their involvement.
• As required by law (for example, mandatory reporting of suspected abuse, neglect, or domestic violence; reporting wounds or injuries as required). • For public health activities, including reporting of disease, vital statistics, FDA-regulated product safety, and exposure communications.
• To health oversight agencies for activities authorized by law.
• For judicial and administrative proceedings, in response to a court order, subpoena, or discovery request, subject to applicable safeguards.
• For law enforcement purposes as permitted by law. Lipedema Warrior Clinic | Legal Policies Page 18 of 33 • To coroners, medical examiners, and funeral directors. • For organ and tissue donation.
• For research, subject to special protections.
• To avert a serious threat to health or safety.
• For specialized government functions (military, national security, protective services).
• For workers' compensation as authorized by law. Uses and Disclosures That Require Your Written Authorization The following uses and disclosures require your written, signed authorization, which you may revoke at any time in writing:
• Most uses and disclosures of psychotherapy notes. • Uses and disclosures for marketing purposes. • Disclosures that constitute a sale of PHI.
• Most other uses and disclosures not described in this Notice.
Your Rights
Right to Inspect and Copy
You have the right to inspect and obtain a copy of your PHI in our designated record set. Requests must be in writing. We will respond within the time required by law. We may charge a reasonable, cost-based fee.
Right to Amend
You have the right to request an amendment to PHI that you believe is incorrect or incomplete. Requests must be in writing and include a reason. We may deny the request in certain circumstances; we will inform you in writing of any denial.
Right to an Accounting of Disclosures
You have the right to request an accounting of certain disclosures of your PHI made by us in the six years preceding your request, excluding disclosures for treatment, payment, healthcare operations, and a few other categories.
Right to Request Restrictions
You have the right to request a restriction on certain uses or disclosures of your PHI. We are not required to agree, except that we must agree to a request not to disclose PHI to a health plan for payment or operations if you have paid for the service in full out of pocket.
Right to Confidential Communications
You have the right to request that we communicate with you about your care in a specific way or at a specific location (for example, by personal email rather than mailing address). We will accommodate reasonable requests. Lipedema Warrior Clinic | Legal Policies Page 19 of 33 Right to a Paper Copy of This Notice You have the right to a paper copy of this Notice at any time, even if you previously agreed to receive it electronically. Right to Be Notified of a Breach You have the right to be notified following a breach of unsecured PHI.
Right to Choose
Someone to Act for You If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your PHI.
Our Duties
• We are required by law to maintain the privacy and security of your PHI.
• We must abide by the terms of this Notice currently in effect.
• We must notify you promptly if a breach occurs that may have compromised the privacy or security of your PHI.
• We must follow the terms of this Notice until it is replaced by a new Notice; the new Notice will be effective for all PHI we maintain.
Complaints If you believe your privacy rights have been violated, you may file a complaint with the Clinic by contacting the Privacy Officer at the address below, or with the U.S. Department of Health and Human Services, Office for Civil Rights, 200 Independence Avenue, S.W., Washington, D.C. 20201, 1-877-696- 6775, www.hhs.gov/ocr/privacy/hipaa/complaints/.
You will not be retaliated against for filing a complaint. Changes to This Notice We reserve the right to change this Notice and make the revised Notice effective for PHI we already have about you as well as any information we receive in the future. The current Notice will be posted in the Clinic, on the Website, and provided on request.
Contact Information Privacy Officer: Liza Maria Rodriguez Jimenez, MD Lipedema Warrior Clinic 9400 SW Beaverton Hillsdale Hwy #250, Beaverton, OR 97005 Phone: (503) 994-6226 Email: info@lipedemawarriorclinic.com
Acknowledgment of Receipt I acknowledge that I have received and reviewed this Notice of Privacy Practices.