Notice of Privacy Practices
This notice explains how Modern Wellness Clinic may use and share your medical information, and how you can access that information. We take the privacy of your health information seriously and are committed to protecting it.Please review this notice carefully to understand your rights and our responsibilities under federal law.
When it comes to your health information, you have certain rights. This section explains your rights and how Modern Wellness Clinic will help you exercise them.
You may request to see or receive an electronic or paper copy of your medical record and other health information we maintain about you. Ask us for details on how to make this request.We will provide a copy or summary of your health information within 30 days of receiving your request, unless otherwise permitted by law. A reasonable, cost-based fee may apply.
If you believe the health information we have about you is incorrect or incomplete, you may request that we correct it. Ask us for instructions on how to submit this request.We may deny your request, but if we do, we will provide you with a written explanation within 60 days.
You may request that we communicate with you in a specific way (for example, by sending mail to a different address or calling you at a certain phone number).We will grant all reasonable requests.
You may request that we not use or share certain health information for treatment, payment, or clinic operations.We are not required to agree to your request, and we may deny it if it would impact your care.If you pay for a service or healthcare item in full, out-of-pocket, you may request that we not share that information with your health insurer for payment or operational purposes.We will agree to your request unless we are required by law to share that information.
You may request a list (accounting) of the times Modern Wellness Clinic has shared your health information during the six years prior to your request. The list will include who we shared the information with, when, and why.This list will not include certain disclosures, such as those made for treatment, payment, or healthcare operations, as well as any disclosures you asked us to make.We will provide one list per year at no cost. If you request another within the same 12-month period, we may charge a reasonable, cost-based fee.
You may request a paper copy of this Notice of Privacy Practices at any time, even if you previously agreed to receive it electronically.We will provide a paper copy promptly upon your request.
If you have designated someone as your medical power of attorney or if a legal guardian has been appointed for you, that person may exercise your rights and make decisions about your health information.We will confirm that the person has the proper authority before taking any action.
If you believe
Modern Wellness Clinic has violated your privacy rights, you may file a complaint with us directly using the contact information provided at the end of this notice.You may also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights: By mail: 200 Independence Avenue, S.W., Washington, D.C. 20201By phone: 1-877-696-6775Online:
www.hhs.gov/ocr/privacy/hipaa/complaints/ We will not retaliate against you for filing a complaint.
For certain types of health information, you can tell Modern Wellness Clinic your preferences about what we share. If you have a clear preference for how we share your information in the situations listed below, let us know, and we will follow your instructions.
Share information with your family, close friends, or others involved in your careShare information in a disaster relief situationInclude your information in a hospital directory. If you are unable to tell us your preference—for example, if you are unconscious—we may share your information if we believe it is in your best interest. We may also share your information if it is needed to help prevent or reduce a serious and imminent threat to health or safety.
Marketing purposes. Sale of your information. Most sharing of psychotherapy notes
How do we typically use or share your health information? At Modern Wellness Clinic, we use or share your health information in the following ways:
We may use your health information and share it with other healthcare professionals involved in your treatment. Example: A provider at Modern Wellness Clinic treating you for an injury may consult another healthcare provider to discuss your overall health condition.
We may use and share your health information to manage our clinic operations, improve the quality of your care, and contact you when needed. Example: We may use health information to coordinate your care plan and ensure you receive appropriate follow-up services.
We may use and share your health information to bill and collect payment from health plans or other entities. Example: We may provide necessary information to your health insurance company so they can process and pay for your services.
How else can we use or share your health information?
We may be allowed or required to share your information in other ways that benefit the public, such as public health and research. These uses are only permitted when certain legal conditions are met.
We may share your health information in certain situations, including: Preventing or controlling disease. Assisting with product recalls. Reporting adverse reactions to medications. Reporting suspected abuse, neglect, or domestic violence. Preventing or reducing a serious threat to anyone’s health or safety.
We may use or share your health information for approved health research projects.
We will share your health information if required by state or federal law, including with the U.S. Department of Health and Human Services to ensure compliance with federal privacy laws.
We may share your health information with authorized organ procurement organizations to facilitate organ or tissue donation and transplantation.
We may use or share your health information for: Workers’ compensation claims. Law enforcement purposes or with a law enforcement official. Activities by health oversight agencies as permitted by law. Special government functions such as military, national security, and presidential protective services
We may share your health information in response to a court or administrative order, or in response to a subpoena.
We do not create or manage a hospital directory. We do not create or maintain psychotherapy notes at this clinic. We will never share any substance abuse treatment records without your written permission, as required by law.
We are required by law to protect the privacy and security of your protected health information. We will notify you promptly if a breach occurs that may have compromised the privacy or security of your information. We will follow the duties and privacy practices described in this notice and provide you with a copy. We will not use or share your information for purposes other than those described in this notice unless you give us written permission. You may change your permission at any time by letting us know in writing .For more information, visit:
www.hhs.gov/ocr/privacy/hipaa/understanding/
consumers/noticepp.html We may change the terms of this notice at any time, and those changes will apply to all information we have about you. The updated notice will be available upon request, in our office, and on our website.
Modern Wellness Clinic :5375 S Fort Apache Rd Suite 102 & 103, Las Vegas, NV 89148. https://www.modernwellnessclinic.com/. Privacy Officer: Robert Webb. Email: robert@modernwellnessclinic.com. Phone:
(702) 463-9159
