AS REQUIRED BY THE PRIVACY REGULATIONS CREATED AS A RESULT OF THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA), THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO YOUR HEALTH INFORMATION.
Please review this notice carefully.
Wellity Health is dedicated to maintaining the privacy of your health information. In conducting our business, we create records regarding you and the treatment and services we provide.
We are required by law to maintain the confidentiality of protected health information (“PHI”) and provide you with notice of our legal duties and privacy practices regarding your PHI.
This Notice explains:
The terms of this Notice apply to all records created or maintained by Wellity Health. We reserve the right to revise this Notice at any time.
If you have questions regarding this Notice, contact:
Wellity Health
39159 Paseo Padre Pkwy, STE 121
Fremont, CA 94538
Phone: 510.952.1190
We may use your PHI to provide medical treatment and services, including prescriptions, diagnoses, laboratory testing, and coordination with pharmacies or health care providers.
We may use and disclose your PHI to bill and collect payment from insurance companies or other entities responsible for payment.
We may use PHI for operational purposes such as quality assessment, business planning, training, and administrative activities.
We may contact you regarding appointments or follow-up care.
We may inform you about treatment options, health-related services, or benefits that may interest you.
We may share PHI with family members, close friends, or others involved in your care or payment for care when appropriate.
We may disclose PHI when required by federal, state, or local law.
Psychotherapy notes receive additional legal protections and restrictions under applicable law.
We may disclose PHI for public health purposes including:
We may disclose PHI for audits, inspections, investigations, licensing, and compliance monitoring.
We may disclose PHI in response to court orders, subpoenas, or lawful legal processes.
We may disclose PHI to law enforcement under specific legal circumstances.
We may disclose PHI to coroners, medical examiners, or funeral directors as required.
Under certain conditions, PHI may be used or disclosed for approved research purposes.
We may disclose PHI to prevent serious threats to health or safety.
We may disclose PHI when required by military authorities.
We may disclose PHI for authorized national security or intelligence activities.
If you are incarcerated, PHI may be disclosed to correctional institutions or law enforcement.
We may disclose PHI for workers’ compensation or similar legally authorized programs.
You have the following rights regarding your PHI:
You may request communications in a specific manner or location.
Requests may be submitted to:
support@wellityhealth.com
You may request restrictions on how PHI is used or disclosed for treatment, payment, or operations.
We are not required to agree unless:
If you paid fully out-of-pocket, you may request that related PHI not be disclosed to your health plan.
You have the right to inspect and obtain copies of your PHI and medical records.
Requests should be submitted to:
Wellity Health
39159 Paseo Padre Pkwy, STE 121
Fremont, CA 94538
Phone: 510.952.1190
Reasonable fees may apply.
You may request electronic copies of electronic medical records.
You may request corrections or amendments to PHI you believe is incorrect or incomplete.
Requests should be submitted to:
Privacy Officer
39159 Paseo Padre Pkwy, STE 121
Fremont, CA 94538
Phone: 510.952.1190
Email: support@wellityhealth.com
Patients may submit written addendums that will be attached to medical records.
You may request a list of certain disclosures of your PHI made within the previous six years.
Requests should be submitted to the Privacy Officer.
You have the right to be notified if unsecured PHI is breached.
You may request a paper copy of this Notice at any time.
You may file a complaint if you believe your privacy rights have been violated.
Complaints should be submitted in writing to:
Wellity Health
39159 Paseo Padre Pkwy, STE 121
Fremont, CA 94538
Phone: 510.952.1190
Email: intake@wellityhealth.com
You will not be penalized for filing a complaint.
Any use or disclosure not covered by this Notice or applicable law requires your written authorization.
You may revoke authorization at any time in writing.
This Notice applies to all Wellity Health providers and affiliated covered entities.
If you have any questions regarding this Notice, contact:
Wellity Health
39159 Paseo Padre Pkwy, STE 121
Fremont, CA 94538
Phone: 510.952.1190
Email: support@wellityhealth.com
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