Patient Privacy

Notice of Privacy Practices

Confidentiality of Your Health Care Information

Physician’s Weight Control and Wellness · Effective January 31, 2019

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.

Download PDF Call Privacy Officer

Who this notice covers

This notice describes Physician’s Weight Control and Wellness privacy practices and that of:

• All employees
• Any intern, volunteer, or IT personnel that we allow to input or maintain patient data files
• All internal departments of Physician’s Weight Control and Wellness Center
• All locations owned by Physician’s Weight Control and Wellness

Our commitment to your privacy

We have always had stringent safeguards to protect private health information (PHI). Because of the law, some practices are set out here so you can see how we protect your health information. In conducting our business, we may receive, create, use, or disclose protected health information regarding you and the treatments and services we provide you. None of your protected health information will leave our office without your written consent, except as described in this notice or as required by law.

Health information security

Physician’s Weight Control and Wellness requires all employees to follow security policies and procedures to safeguard your PHI.

Understanding your medical record information

The information we have on you is called your private health information (PHI). We create a record of the care and services you receive in our office. This record may contain your prescription information, doctor’s progress notes, medical history, or other documentation the doctor chooses to include in your medical record.

This notice summarizes:

• How we use and disclose your PHI
• Your privacy rights regarding your PHI
• Our obligations concerning the use and disclosure of your PHI

How we may use and disclose medical information about you

For treatment

We will use health information about you to provide medical treatment or services. Our doctors, medical assistants, and office personnel will have access to your health information as needed to care for you.

For health care operations

We may use your protected health information to perform our daily business activities, which may include data management, customer service, complying with laws, and quality improvement. Your health information may be used to evaluate the performance of our staff in caring for you. We may also use health information about all or many of our patients to help us decide what additional services we should offer or how we can become more efficient.

To avert a serious threat to health or safety

We may use and disclose 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. Any disclosure would be to someone able to help stop or reduce the threat.

Research

We may use and disclose health information about you for research projects that are subject to a special approval process. We will ask you for your permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care at the office.

Military

If you are, or were, a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release information about foreign military personnel to the appropriate foreign military authority.

Public health risks

We may disclose health information about you for public health activities. These activities generally include, but are not limited to:

• To prevent or control disease, injury, or disability
• To regulate products subject to FDA regulations
• To notify the appropriate government agency if we think a patient has been the victim of abuse, neglect, or domestic violence

Health oversight activities

We may disclose health information to a health oversight agency for audits, investigations, inspections, accrediting, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the health care system, government programs, and compliance with civil rights laws. Generally, these audits are done in our office and will not require a signed consent from you.

As required by law

We will disclose health information about you when required to do so by federal, state, or local law.

Judicial proceedings

If you are involved in a lawsuit or a dispute and we are asked to disclose health information about you in response to a court order or subpoena, we will comply with those orders as required by law.

Law enforcement

We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons, or similar process, subject to all applicable legal requirements.

Coroners, medical examiners, and funeral directors

We may release health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death, or as necessary to carry out their duties. If you have listed someone you do not want your records revealed to, that person would not be allowed to get a copy of your PHI even in the event of your death.

Information not personally identifiable

We may use or disclose health information about you in a way that does not personally identify you or reveal who you are. This is usually generic information to help improve or create new medications.

Individuals involved in the treatment or payment of your care

We may disclose health information about you to your family members or friends if we obtain written consent from you to do so.

Business associates

There are some services that we provide through contracts with third-party business associates. Examples include external laboratories and information technology associates. To protect your health information, PWCWC requires business associates to sign a disclosure agreement before they can have access to any information pertaining to the company or patients.

Consent forms

You may revoke any consent form at any time by giving us written notice. Your revocation will be effective when we receive your written notice. Any disclosures prior to receiving your written revocation of that particular consent form will not be subject to your revocation.

Your rights regarding health information about you

You have the following rights regarding health information we maintain about you.

Right to inspect and copy

You have the right to inspect and request a copy of certain health information we have on file. Usually, this includes medical and billing records. To inspect and request a copy of health information on file about you, you must submit a written request. If you request a copy of your health information, we may charge a fee for the costs of copying, mailing, or other associated supplies. (Our office does not use electronic record keeping so your records cannot be transferred to you electronically.)

We may deny your request to inspect or receive a copy in certain limited cases. If we deny your request, you may ask for a review of the denial. The person who conducts the review will not be the person who denied the request. We will comply with the outcome of the review.

Right to request an amendment

If you believe medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment as long as the information originated at PWCWC. You must request an amendment in writing and submit it to the Privacy Officer. You must also tell us the reason for your request. The request to amend your record may be denied, in which case you have the right to enter a statement into your record saying that you disagree with the decision.

Right to an accounting of disclosures

You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of medical information about you for purposes other than treatment, payment, and health care operations. To obtain this list, you must submit your request in writing to the Privacy Officer. It must state a time period, which may not be longer than six years. We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to request restrictions

You have the right to request a restriction or limitation on the health information we disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for it, like a family member or friend. We are not required to agree to your request, but if we do agree, we will comply with your request unless the information is needed to provide emergency treatment for you.

You must submit your request for restrictions in writing to the Privacy Officer. In your request, you must tell us: (1) the information you want restricted; and (2) to whom you want the restrictions to apply, such as your spouse or another relative. The Privacy Officer will inform you if disclosure is made to someone on your restricted list; this disclosure will only be made in case of a health emergency.

Right to request confidential communications

You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. You must submit your request for confidential communication in writing. Your request must specify how or where we should contact you. We will try to accommodate all reasonable requests. (We have a form you can use for this purpose.)

Other uses of medical information

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will only be made with your written permission. If you provide us with permission to use or share your medical information, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or share your health information for the reasons in your written revocation. Any information disclosed before your written revocation will not be subject to this revocation.

Changes to this notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have, as well as information we receive in the future. We will post copies of the current notice on our website, www.drweightcontrol.com. The notice will contain the effective date of the notice near the top of the first page.

Right to a paper copy of this notice

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. This notice is also available on our website and as a downloadable PDF.

For more information or to report a problem

If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. All complaints must be in writing. There will be no retaliation for filing a complaint.

Website use

This page is our Notice of Privacy Practices for protected health information related to care at Physician’s Weight Control and Wellness. When you use this website, we may also collect limited technical information (such as pages visited and standard server logs) needed to operate and improve the site. We do not sell your personal information. For questions about website privacy in addition to this clinical notice, contact our office using the Privacy Officer details above.