Notice of privacy practices.

Your rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

• Get a copy of your health and billing records. We will give you a copy, electronically if you prefer, within 15 business days of your written request. We may charge a reasonable, cost-based fee.
• Ask us to correct your record if you think it is incorrect or incomplete. We may say no, but we’ll tell you why in writing within 60 days.
• Ask us to contact you in a specific way (for example, only by phone, or only through the secure patient portal) or at a different address. We will say yes to all reasonable requests.
• Ask us to limit what we use or share. We are not required to agree if it would affect your care. If you pay for a service in full out of pocket, you can ask us not to share that information with your health insurer, and we will say yes unless a law requires us to share it.
• Get a list of the times we’ve shared your information in the six years before you ask, who we shared it with, and why. It won’t include sharing for treatment, payment or running our practice, or certain other sharing. One list a year is free.
• Get a paper copy of this notice at any time, even if you agreed to receive it electronically.
• Choose someone to act for you. If you have given someone medical power of attorney, or someone is your legal guardian, that person can use your rights. We will confirm they have this authority first.
• File a complaint if you feel your rights have been violated. See “How to file a complaint” below.

Your choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference, tell us and we will follow your instructions.

• You can tell us whether to share information with your family, close friends or others involved in your care, and whether to share it in a disaster-relief situation. If you are unable to tell us (for example, if you are unconscious), we may share information if we believe it is in your best interest, or when needed to lessen a serious and imminent threat to health or safety.
• We never sell your health information.
• We may use your contact details to tell you about our own services, memberships and offers. You can opt out at any time. We never share your information with other companies for their marketing, and we never accept payment to send you messages about another company’s products without your written permission.
• We never share psychotherapy notes without your written permission (we do not keep them).

How we typically use or share your health information

• To treat you: we use your health information and share it with other professionals who are treating you (for example, a lab that processes your blood panel, or your doctor).
• To run our practice: for example, to improve care, train staff and contact you about appointments.
• To get paid: we use your information to process your payment and, if you ask, give you an itemized receipt to send to your HSA, FSA or insurer.
• With our business associates: companies that help us operate (such as our electronic records and booking system) may receive information to do that work, under a written agreement to protect it.

How we communicate with you

• We send appointment reminders and care messages by text and email through our secure scheduling and records system.
• Regular email and text messages may not be encrypted. You can ask us to use only the secure patient portal.
• Telehealth visits take place on a secure video platform, under a business associate agreement that requires it to protect your information.

Photos

Clinical photos are part of your medical record. We never post or share identifiable photos, your name or your story publicly without your separate written authorization.

Other ways we may use or share your information

We are allowed or required to share your information in other ways, usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share it for these purposes:

• Public health and safety: preventing disease, reporting adverse reactions to medications, reporting suspected abuse, neglect or domestic violence, and preventing or reducing a serious threat to anyone’s health or safety.
• Research, under conditions the law sets.
• When the law requires it, including to the Department of Health and Human Services to show we comply with federal privacy law.
• Organ and tissue donation requests, and working with a medical examiner or funeral director.
• Workers’ compensation claims, law enforcement purposes or a law enforcement official, health oversight agencies, and special government functions such as military, national security and presidential protective services.
• In response to a court or administrative order, or to a subpoena.

Substance use disorder records

If we receive records of substance use disorder treatment from a federally assisted program protected by 42 CFR Part 2, we will not use or share those records, or testimony about them, in any civil, criminal, administrative or legislative proceeding against you unless you give written consent, or a court orders it after you have had notice and a chance to be heard and the order comes with a subpoena or other legal requirement.

Electronic disclosure (Texas)

Texas law requires us to tell you that your protected health information may be subject to electronic disclosure. We keep records electronically and may share them electronically for the purposes described in this notice. Except as allowed by law, we will not disclose your information electronically without your authorization.

Our responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by letting us know in writing.

Changes to this notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available on request, in our office and on this website.

How to file a complaint

• With us: write to our Privacy Officer (address below), email wanda@foreveryoungivbar.com or call 469-613-7033.
• With the U.S. Department of Health and Human Services Office for Civil Rights: 200 Independence Avenue S.W., Washington, D.C. 20201; 1-877-696-6775; or online at hhs.gov/ocr/privacy/hipaa/complaints.
• We will not retaliate against you for filing a complaint.

Privacy Officer

Wanda Orange, MSN, APRN, NP-C, Privacy Officer. Forever Young IV Bar, 2609 Technology Drive, Suite 108, Plano, TX 75074 · 469-613-7033 · wanda@foreveryoungivbar.com.

This notice applies to Forever Young IV Bar ("the Practice", "we", "us", "our").