HIPPA Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The terms of this Notice of Privacy Practices (“Notice”) apply to Body Fluent Wellness LLC, its affiliates, and its employees. Body Fluent Wellness LLC will share clients' protected health information as necessary to carry out treatment, payment, and healthcare operations as permitted by law. We are required by law to maintain the privacy of our clients' protected health information and to provide clients with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this Notice for as long as it remains in effect. We reserve the right to change the terms of this Notice as necessary and to make a new notice of privacy practices effective for all protected health information maintained by Body Fluent Wellness LLC. We are required to notify you in the event of a breach of your unsecured protected health information. We are also required to inform you that there may be a provision of state law related to the privacy of your health information that may be more stringent than a standard or requirement under the Federal Health Insurance Portability and Accountability Act (“HIPAA”). A copy of any revised Notice of Privacy Practices or information pertaining to a specific State law may be obtained by mailing a request to the Privacy Officer at the address below.

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION:

Authorization and Consent: Except as outlined below, we will not use or disclose your protected health information for any purpose other than treatment, payment, or healthcare operations unless you have signed a form authorizing such use or disclosure. You have the right to revoke such authorization in writing, with such revocation being effective once we receive the writing; however, such revocation shall not be effective to the extent that we have taken any action in reliance on the authorization or if the authorization was obtained as a condition of obtaining insurance coverage, other law provides the insurer with the right to contest a claim under the policy or the policy itself.

Uses and Disclosures for Treatment: We will make uses and disclosures of your protected health information as necessary for your treatment. Doctors, nurses, and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to your course of treatment, which may include procedures, medications, tests, medical history, etc.

Uses and Disclosures for Payment: We will make uses and disclosures of your protected health information as necessary for payment purposes. During the normal course of business operations, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you. We may also use your information to prepare a bill to send to you or the person responsible for your payment.

Uses and Disclosures for Health Care Operations: We will make uses and disclosures of your protected health information as necessary and as permitted by law for our health care operations, which may include clinical improvement, professional peer review, business management, accreditation, and licensing, etc. For instance, we may use and disclose your protected health information to improve clinical treatment and client care. Individuals Involved In Your Care: We may occasionally disclose your protected health information to designated family, friends and others who are involved in your care or in payment of your care to facilitate that person's involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval. We may also disclose limited protected health information to a public or private entity authorized to assist in disaster relief efforts for that entity to locate a family member or other persons who may be involved in some aspect of caring for you.

Business Associates: Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, outcomes data collection, legal services, etc. At times, we may need to provide your protected health information to one or more of these outside persons or organizations who assist us with our healthcare operations. In all cases, we require these associates to safeguard the privacy of your information appropriately.

Appointments and Services: We may contact you to provide appointment updates or information about your treatment or other health-related benefits and services that may be of interest to you. You have the right to request, and we will accommodate, reasonable requests by you to receive communications regarding your protected health information from us by alternative means or at alternative locations. For instance, we will accommodate reasonable requests if you wish appointment reminders not to be left on voice mail or sent to a particular address. With such requests, you must provide an appropriate alternative address or method of contact. You also have the right to request that we not send you any future marketing materials, and we will use our best efforts to honor such request. You must make such requests in writing, including your name and address, and send such writing to the Privacy Officer at the address below.

Research: In limited circumstances, we may use and disclose your protected health information for research purposes. In all cases where your specific authorization is not obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board that oversees the research or by representations of the researchers that limit their use and disclosure of your information.

Other Uses and Disclosures: We are permitted and/or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization for the following:

• Any purpose required by law;

• Public health activities such as required reporting of immunizations, disease, injury, birth, and death, or in connection with public health investigations;

• If we suspect child abuse or neglect; if we believe you to be a victim of abuse, neglect, or domestic violence;

• To the Food and Drug Administration to report adverse events, product defects, or to participate in product recalls;

• To your employer when we have provided health care to you at the request of your employer;

• To a government oversight agency conducting audits, investigations, civil or criminal proceedings;

• Court or administrative-ordered subpoena or discovery request;

• To law enforcement officials as required by law if we believe you have been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law;

• To coroners and/or funeral directors consistent with law;

• If you are a member of the military, we may also release your protected health information for national security or intelligence activities and

• To workers' compensation agencies for workers' compensation benefit determination.

Any disclosure of your protected health information other than those stated above requires your written authorization.

RIGHTS THAT YOU HAVE REGARDING YOUR PROTECTED HEALTH INFORMATION:

Access to Your Protected Health Information: You have the right to copy and/or inspect much of the protected health information we retain on your behalf. For protected health information we maintain in any electronic designated record set, you may request a copy of such health information in a reasonable electronic format if readily available. Access requests must be made in writing and signed by you or your legal representative. You may obtain a "Patient Access to Health Information Form" from the Privacy Officer below. You will be charged a reasonable copying fee and actual postage and supply costs for your protected health information. If you request additional copies, you will be charged a fee for copying and postage.

Amendments to Your Protected Health Information: You have the right to request in writing that protected health information that we maintain about you be amended or corrected. We are not obligated to make requested amendments, but we will carefully consider each request. All amendment requests must be in writing, signed by you or your legal representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made, we may notify others who work with us if we believe such notification is necessary. You may obtain an "Amendment Request Form" from the Privacy Officer below.

Accounting for Disclosures of Your Protected Health Information: You have the right to receive an accounting of certain disclosures made by us of your protected health information. Requests must be made in writing and signed by you or your legal representative. "Accounting Request Forms" are available from the Privacy Officer below. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period. You will be notified of the price at the time of your request.

Restrictions on Use and Disclosure of Your Protected Health Information: You have the right to request restrictions on uses and disclosures of your protected health information for treatment, payment, or health care operations. We are not required to agree to most restriction requests but will attempt to accommodate reasonable requests when appropriate. You do, however, have the right to restrict disclosure of your protected health information to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the protected health information pertains solely to a healthcare item or service for which you, or someone other than the health plan on your behalf, has paid Body Fluent Wellness LLC in full. If we agree to any discretionary restrictions, we reserve the right to remove such restrictions as we appropriate. We will notify you if we remove a restriction imposed in accordance with this paragraph. You also have the right to withdraw, in writing or orally, any restriction by communicating your desire to do so to the Privacy Officer below.

Right to Notice of Breach: We take very seriously the confidentiality of our clients’ information, and we are required by law to protect the privacy and security of your protected health information through appropriate safeguards. We will notify you in the event a breach occurs involving or potentially involving your unsecured health information and inform you of what steps you may need to take to protect yourself.

Paper Copy of this HIPPA Notice of Privacy Practices: You have a right, even if you have agreed to receive notices electronically, to obtain a paper copy of this HIPPA Notice of Privacy Practices. To do so, please submit a request to the Privacy Officer below.

Effective Date: January 2, 2020

Privacy Officer
Body Fluent Wellness LLC
230 West 79th Street
New York, NY 10024
Phone: 917-383-3005
info@bodyfluentwellness.com