Notice of Privacy Practices
Questions about this notice can be directed to:
Eleve Concierge Wellness, PNC
Email: contact@elevewellness.org
Phone: (310) 633-1907
This notice outlines your protected health information, how it may be used, and what your rights are. Please review carefully and ask any questions prior to signing.
OUR PLEDGE REGARDING PROTECTED HEALTH INFORMATION
We, Eleve Concierge Wellness, PNC understand that protected health information about you and your health is personal. We are committed to protecting health information about you. This Notice applies to all records of your care generated by Eleve Concierge Wellness, PNC. This Notice will tell you about the ways in which we may use and disclose protected health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of protected health information.
The law requires us to:
Keep protected health information that identifies
you privateNotify you about how we protect protected health information about you
Explain how, when, and why we use and disclose protected health information
Follow the terms of the Notice that is currently in effect
Notify you in the event of a breach of your unsecured protected health information
We are required to follow the procedures in this Notice. We reserve the right to change the terms of this Notice and to make new notice provisions effective for all protected health information that we maintain by posting the revised Notice on our website and making copies available upon request.
HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose protected health information without your written authorization.
For Treatment: We may use protected health information about you to provide, coordinate, or manage your medical treatment or services. We may disclose protected health information about you to other healthcare providers who are involved in your care, including but not limited to specialists, laboratories, and pharmacies. We may use and disclose protected health information to contact you as a reminder that you have an appointment for treatment or medical care. We may use and disclose protected health information to tell you about possible treatment options, alternatives, or health-related benefits or services.
For Payment for Services: We may use and disclose protected health information about you so that the treatment and services you receive may be billed and payment collected from you. As a self-pay practice, we do not currently bill insurance carriers directly. However, we may provide you with an itemized superbill or receipt upon request to support any independent insurance submission you choose to pursue on your own behalf. If our billing practices change, patients will be notified and provided with an updated Notice of Privacy Practices.
For Health Care Operations: We may use and disclose protected health information about you for health care operations, such as quality assessment and improvement activities, case management, coordination of care, business planning, and customer service. These uses and disclosures are necessary to operate the practice and ensure that all patients receive quality care. We may remove information that identifies you from this set of protected health information so others may use it to study healthcare and healthcare delivery without learning who the specific patients are.
As Required By Law: We will disclose protected health information about you when required to do so by federal, state, or local law.
Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your information.
Health Risks: We may disclose protected health information about you to a government authority 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 or lessen a serious and imminent threat to you or another person.
Judicial and Administrative Proceedings: If you are involved in a lawsuit or dispute, we may disclose your information in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process, but only if efforts have been made to tell you about the request or to obtain an order
protecting the information requested.
Business Associates: We may disclose information to business associates who perform services on our behalf, such as our electronic health record platform. We require all business associates to appropriately safeguard your information under a written Business Associate Agreement.
Public Health: As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
To Avert a Serious Threat to Health or Safety: We may use and disclose protected health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law, including audits, investigations, and inspections necessary for licensure and government monitoring of the healthcare system.
Law Enforcement: We may release protected health information as required by law, or in response to a court order, warrant, subpoena, or administrative request. We may also disclose protected health information in response to a request related to identification or location of an individual, victims of crime, or a crime on the premises.
Mandatory Reporting: As required by California law, we are obligated to report suspected child abuse, elder abuse, and dependent adult abuse to the appropriate authorities.
Coroners and Medical Examiners: We may release protected health information to a coroner or medical examiner as necessary to identify a deceased person or determine the cause of death.
Organ and Tissue Donation: If you are an organ donor, we may release protected health information to organizations that handle organ procurement, transplantation, or donation to facilitate organ or tissue donation and transplantation.
Correctional Institutions: If you are or become an inmate of a correctional institution or are in the custody of a law enforcement official, we may release protected health information about you to the correctional institution or law enforcement official as necessary for your health and safety or the health and safety of others.
Military and Special Government Functions: If you are a member of the armed forces or a veteran, we may release protected health information about you as it relates to military activities, fitness for duty determinations, or coordination with the Department of Veterans Affairs. We may also release protected health information for national security and intelligence purposes as required by law.
Worker's Compensation: We may disclose information as necessary to comply with laws relating to worker's compensation or other similar programs established by law.
Food and Drug Administration: We may disclose protected health information to the FDA relative to adverse events with respect to drugs, foods, supplements, or products to enable product recalls, repairs, or replacement.
Fundraising: We may contact you as part of a fundraising effort to support Eleve Concierge Wellness or affiliated nonprofit programs. We will only use basic contact information and dates of service for this purpose. You have the right to opt out of receiving fundraising communications at any time by contacting us at contact@elevewellness.org or (310) 633-1907.
DISCLOSURE TO FAMILY MEMBERS AND THIRD PARTIES
We will not share your protected health information with family members, relatives, friends, or any other third party without your prior written authorization. If you would like to authorize disclosure of your health information to a designated individual, please request a separate Authorization for Release of Health Information form from your provider.
We may share information with a public or private agency for disaster relief purposes. Even if you object, we may still share this information if necessary for emergency circumstances.
If you have any questions about the use and disclosure of your protected health information, please contact us at:
Email: contact@elevewellness.org
Phone: (310) 633-1907
BREACH NOTIFICATION
In the event of a breach of your unsecured protected health information, we will notify you as required by federal and California law. Notification will be provided without unreasonable delay and in no case later than 60 days following discovery of the breach. We will inform you of what information was involved, what steps you can take to protect yourself, what we are doing to investigate and address the breach, and who you can contact for more information.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU
You have the following rights regarding protected health information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy protected health information that may be used to make decisions about your care. To do so, you must submit your request in writing to Eleve Concierge Wellness, PNC. We may charge a reasonable fee for copying and will respond to your request no later than 30 days after receiving it.
Right to Amend: If you feel that protected health information we have about you is incorrect or incomplete, you may ask us to amend or supplement the information. Requests must be made in writing with a supporting reason. We will act on your request no later than 60 days after receiving it. We may deny your request if the information was not created by us, is not part of the records we maintain, or we believe is accurate and complete.
Right to an Accounting of Disclosures: You have the right to request a list of disclosures we have made of your protected health information. To request this list, you must submit your request in writing. The first list you request within a 12-month period will be free. For additional lists, we may charge a reasonable fee.
Right to Request Restrictions: You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment, or health care operations. We are not required to agree to your request. To request restrictions, you must make your request in writing to Eleve Concierge Wellness, PNC.
Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you must make your request in writing. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice at any time by contacting us at contact@elevewellness.org or (310)633-1907.
OTHER USES AND DISCLOSURES
We will obtain your written authorization before using or disclosing your protected health information for purposes other than those provided for above or as otherwise permitted or required by law. You may revoke this authorization in writing at any time. Upon receipt of the written revocation, we will stop using or disclosing your information, except to the extent that we have already taken action in reliance on the authorization.
YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES
If you believe your privacy rights have been violated, you may file a complaint with Eleve Concierge Wellness, PNC by contacting us at contact@elevewellness.org or (310) 633-1907. You may also file a written complaint with the Secretary of the Department of Health and Human Services. We will not take any action against you or change our treatment of you in any way as a result of filing a complaint.