Able Weight Loss Center

Weight Loss and Longevity Center
2151 E. Commercial Blvd., Suite 201, Ft. Lauderdale, FL 33008
Notice of Privacy Practices For Protected Health Information
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

Weight Loss and Longevity Center, and its affiliated health care providers (collectively, the “Clinic”; sometimes referred to as “us” or “we” within this Notice), are committed to the privacy of your personally identifiable health information and will use strict privacy standards to protect it from unauthorized use or disclosure. This Notice informs you of the Clinic’s privacy practices and of certain rights available to you under applicable federal and state law.

Overview of Policies
The Clinic is required by law to implement policies designed to ensure the privacy of your personally identifiable health information that is transmitted or maintained by the Clinic. This Notice refers to such information as Protected Health Information, or “PHI.” In addition, the Clinic is required to make this Notice available to you for the purpose of informing you about:

The Clinic’s policies regarding its use and disclosure of your PHI; and
Your privacy rights and other rights with respect to your PHI, including the right to file complaints with the Clinic or with the Secretary of the United States Department of Health and Human Services.

If you have any questions regarding this Notice or the Clinic’s privacy practices, please contact the Privacy Officer at 954-771-8785.

Effective Date
The effective date of this Notice, and of the policies described below, is October 1, 2003 (the “Effective Date”). The Clinic’s use or disclosure of your PHI from and after the Effective Date will be governed by the policies described in this Notice.

I. Use and Disclosure of Protected Health Information

A. Uses and Disclosures That Are Permitted Without Your Consent or Authorization. The Clinic is permitted to use and disclose your PHI without obtaining your consent or authorization in connection with certain treatment activities, payment activities, health care operations, and other limited activities described below. This Notice describes how the Clinic will use or disclose your PHI under such circumstances.

Treatment. Treatment is the provision, coordination or management of health care and related services. The Clinic may use and disclose your PHI in connection with its own treatment-related activities, such as direct medical treatment and activities related to continuity and coordination of care and referrals among the Clinic and physicians and other health care professionals providing you with treatment or consulting in your care. In addition, the Clinic may disclose your PHI to other health care professionals who are providing you with medical services. For example, the Clinic may disclose your health information to physicians who provide you with medical treatment.
Payment. Payment includes, but is not limited to, the preparation and submission of claims and other actions required to secure payment for health care services provided by the Clinic or other health care providers (such as billing, claims management, collection activities, participation in reviews for medical necessity and/or appropriateness of care, utilization review and pre-authorization of health care services). The Clinic may use and disclose your PHI in connection with its own payment-related activities or those of your health care provider(s), other insurer(s) and health plans and other covered entities. For example, the Clinic may use your PHI to prepare and submit claims for reimbursement by Medicare, Medicaid, and other governmental and commercial third-party payors.
Health Care Operations. Health Care Operations include most of the business operations of the Clinic related to health care or related services. They may include (a) quality review and improvement programs; (b) reviewing qualifications and competence of health care providers; (c) underwriting, premium rating and other activities related to creating or renewing insurance contracts; (d) case management activities; (e) legal services and auditing; (f) business planning and development; and (g) other general business and administrative functions. The Clinic may use and disclose protected health information about you as needed for its Health Care Operations and for certain operations of other health care providers, health plans and other covered entities. For example, the Clinic may use PHI as part of its quality review process, to confirm that the Clinic and its associated health care providers are providing the highest quality of care to you and other patients.
Treatment Alternatives; Related Benefits and Services. The Clinic may use your medical information to contact you with appointment reminders and to inform you of (i) possible treatment options or alternatives, or (ii) health-related benefits or services that may be of interest to you.
Fundraising. The Clinic may also make use of certain limited portions of your PHI to contact you for fundraising purposes. In contacting you for fundraising purposes, the Clinic may not make use of information other than (i) your demographic information (name, address, age, etc.) and (ii) the date(s) on which you received treatment at, or through, the Clinic. The Clinic will not include you in our Fundraising if you notify the Clinic at time of admission that you do not wish to be included. You may also contact the Privacy Officer at any time to be taken off the Fundraising list.

B. Uses and disclosures that require that you be given a prior opportunity to agree or disagree. The Clinic is permitted to release your PHI to a close friend, family member or other individual who is involved in your medical care, or who helps pay for your care, if (i) the PHI is directly relevant to the person’s involvement with your care or payment for that care, and (ii) you have either agreed to the disclosure or have been given an opportunity to object and have not objected. The Clinic is not required to give you the opportunity to agree or object to disclosure if your condition would prevent you from doing so and the Clinic determines that disclosure is in your best interests. In addition, the Clinic maintains a directory of patients in its facilities, including their Name, location, general condition and religious affiliation. Directory information is maintained only with respect to patients receiving inpatient care at the Clinic and will be released solely to (i) members of the clergy and (ii) persons who ask for you by name.

The Clinic will not include you in its directory or disclose your directory information if you notify the Clinic at time of admission that you do not wish to be included and/or to have your information released. Finally, the Clinic may also release PHI to certain authorities, such as police, emergency personnel or disaster relief personnel so that they may notify your family about your condition and location.

C. Uses and disclosures for which the Clinic is not required to secure your consent or authorization or provide you with the opportunity to object Use and disclosure of your PHI is allowed without your consent or authorization, and without giving you the opportunity to object, under the following circumstances:

When the use or disclosure is required by law.
When permitted for purposes of public health activities, including reports to public health authorities authorized by law to collect or receive information for the purpose of preventing or controlling disease. The Clinic is also permitted to use or disclose PHI if you have been exposed to a communicable disease or are at risk of spreading a disease or condition, if authorized by law.
When authorized by law to report information about abuse, neglect or domestic violence to public authorities, if there exists a reasonable belief that you may be a victim of abuse, neglect or domestic violence. In such case, the Clinic will promptly inform you that such a disclosure has been or will be made unless that notice would cause a risk of serious harm or such notice would be provided to your personal representative and the Clinic believes your personal representative may be responsible for the abuse, neglect or domestic violence giving rise to the report.
The Clinic may disclose your PHI to a public health oversight agency for health oversight activities authorized by law. This includes uses or disclosures in civil, administrative or criminal investigations; inspections; licensure and disciplinary actions; and other activities necessary for appropriate oversight of the health care system or government benefit programs (such as the Medicare and Medicaid programs).
The Clinic may disclose your PHI in the course of any judicial or administrative proceeding. For example, your PHI may be disclosed in response to a subpoena or discovery request, subject to certain conditions. One of those conditions is that, if the subpoena or discovery request is not accompanied by a court order, written assurances must be given to the Clinic that (i) the requesting party has made a good faith attempt to provide written notice to you, together with information sufficient to permit you to raise an objection, and (ii) you did not object or any objections were resolved in favor of disclosure by the court or tribunal.
When required for law enforcement purposes, as set forth in federal privacy regulations (for example, to report certain types of wounds). The Clinic may also release certain PHI (i) upon request to law enforcement officials for the purpose of identifying or locating a suspect, material witness or missing person, (ii) about an individual who is or is suspected to be a victim of a crime, if the individual agrees to the disclosure or the Clinic is unable to obtain the individual's agreement because of emergency circumstances and certain other conditions are met.
To a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death or performing other duties, all as authorized by law. The Clinic may also disclose a decedent’s PHI to a funeral director, consistent with applicable law, as necessary for the director to carry out his or her duties with respect to the decedent.
The Clinic may use or disclose PHI for research, subject to conditions imposed by federal and state law.
When consistent with applicable law, if the Clinic, in good faith, believes the use or disclosure of PHI is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public and the disclosure is to a person reasonably able to prevent or lessen the threat, including the target of the threat.
When authorized by and to the extent necessary to comply with workers' compensation or other similar programs established by law.
The Clinic is required to disclose your PHI upon request to the Secretary of the U.S. Department of Health and Human Services in connection with the Secretary’s investigation of the Clinic’s compliance with federal privacy regulations.

E. Uses and disclosures that require your written authorization. Except as otherwise indicated in this Notice, uses and disclosures of your PHI will be made only with your written authorization. Uses and disclosures requiring your written authorization may include, for example, the use or disclosure of PHI for marketing purposes. In addition, the Clinic is generally required to obtain your written authorization before using or disclosing psychotherapy notes about you. If you authorize the Clinic to use or disclose your PHI in a manner described in this paragraph, you have the right to revoke that authorization, in writing, at any time. If you revoke your authorization, the Clinic will thereafter refrain from using or disclosing your PHI in the manner described in the authorization.

II. Your Rights Regarding Protected Health Information

You have certain rights regarding PHI held or maintained by the Clinic. This section summarizes those rights.

A. Right to Request Restrictions on the Clinic’s Use and Disclosure of PHI. You have the right to request restrictions (in addition to those described in this Notice) on the Clinic’s use and disclosure of PHI under Sections I.B and I.C, above. The Clinic is not required to agree with your request. If we do agree, we will comply with your request unless the use or disclosure of the PHI in question is required to provide you with emergency treatment. If you wish to request a restriction or limitation on our use or disclosure of PHI, as described in this paragraph, you must make your request in writing to the Weight Loss and Longevity Center, Privacy Officer. Upon receiving such request, we will notify you if we agree or disagree to your requested limitations.

B. Right to Receive Confidential Communications. You have the right to request that you receive communications of PHI from the Clinic in a certain way or at a certain location. For example, you may request that the Clinic communicate with you only at work or by mail. To make a request for confidential communications, please submit your request in writing to the Weight Loss and Longevity Center, Privacy Officer. You are not required to provide a reason for your request, and the Clinic will accommodate all reasonable requests. Please be sure to specify in your request how or where you wish to be contacted.

C. Right to Inspect and Copy Medical Information. Subject to certain limitations, you have the right to inspect and obtain a copy of your PHI. This includes most PHI maintained by the Clinic, except for psychotherapy notes and information compiled by the Clinic in anticipation of legal proceedings. If you wish to inspect and copy your PHI, you must submit a request in writing to the Weight Loss and Longevity Center, Privacy Officer. If you request a copy of PHI, the Clinic may charge a fee to cover the cost of providing a copy of such information to you. The Clinic is also permitted to deny your request to inspect and copy PHI under certain very limited circumstances. If we do deny your request, you may (under most circumstances) request that the denial be reviewed, in which event that Clinic will select a licensed health care professional to review your request and our denial. The Clinic will thereafter comply with the decision of the reviewing official.

D. Right to Amend PHI. You have the right to request that the Clinic amend PHI if you believe that such information is inaccurate or incomplete. Your request must be in writing and directed to the Weight Loss and Longevity Center, Privacy Officer. Your request must contain your reason for believing that such information is inaccurate or incomplete. The Clinic may deny your request for amendment if it determines that the information at issue:

was not created by the Clinic, unless you submit evidence providing a reasonable basis to believe that the originator of such PHI is no longer available to make the amendment;
is not part of the medical information maintained by the Clinic;
is not part of the PHI that you have the right to inspect and copy (as described above); or
is accurate and complete.

E. Right to an Accounting of the Clinic’s Use and Disclosure of Your PHI. You have the right to request an “accounting,” or list, of all disclosures by the Clinic of your PHI other than disclosures that are (i) described in Sections I.A, I.B, or I.C of this Notice; (ii) made for national security or intelligence purposes; or (iii) made to law enforcement officials. Your request for an accounting must be submitted in writing to the Weight Loss and Longevity Center, Privacy Officer. We are not required to list disclosures which took place before October 1, 2003 or that took place more than six (6) years prior to the date of your request. The Clinic will respond to all requests under this paragraph within sixty (60) days by either (a) providing you with the requested accounting, or (b) notifying you in writing of the Clinic’s inability to respond within 60 days and of the date on which you may expect a response. If you make more than one request under this paragraph within a twelve (12) month period, the Clinic will impose a fee to cover its costs in providing the requested information.

F. Right to Paper Copy. You have a right to receive a paper copy of this Notice, even if you have received a copy of this Notice electronically, upon request. If you desire to receive this Notice electronically, you may do so at our web site, [http://www.ableweightloss.com]. For a paper copy of this Notice, please submit a request in writing to the Weight Loss and Longevity Center, Privacy Officer.

III. Organized Health Care Arrangement
The Clinic, the independent contractor members of its Medical Staff (including your physician), and other health care providers affiliated with the Clinic have agreed, as permitted by law, to share your health information among themselves for purposes of your treatment, payment or health care operations. This enables us to better address your health care needs.

IV. Changes to this Notice
The Clinic is required by law to maintain the privacy of your PHI and to provide you with this Notice so that you are aware of our obligation to protect such information. For so long as this Notice remains in effect, the Clinic is required by law to comply with the terms of this Notice.

However, we reserve the right to change this Notice at any time and in any manner that is permitted under applicable law. We also reserve the right to make the new Notice provisions effective for all of your PHI in the Clinic’s possession on the date of any such amendment, as well as for any information the Clinic thereafter receives or generates. If we change the contents of this Notice, we will promptly post a copy of the revised Notice in a clear and prominent location at the Clinic and will make the revised Notice available at the Clinic. In addition, you may always request a copy of the current Notice at any time, as described above.

V. Complaints
You have the right to file a complaint with the Clinic or with the Secretary of the Department of Health Human Service if you believe that your privacy rights have been violated. If you wish to file a complaint with the Clinic, please contact:

Weight Loss and Longevity Center
Privacy Officer
2151 E. Commercial Blvd., Suite 201
Fort Lauderdale, FL 33008

If you wish to file a complaint with the Secretary of HHS the address is:

Office for Civil Rights
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201

October 2003