Effective Date: October 9, 2025
Version: 1.0
Your Information. Your Rights. Our Responsibilities.
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.
Your Rights
- Get a copy of your medical records
- Request corrections to your medical records
- Request confidential communications
- Ask us to limit information we share
- Get a list of those with whom we've shared information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you feel your rights are violated
Our Uses and Disclosures
We may use and share your information as we:
- Treat you - We can use your health information and share it with other professionals who are treating you.
- Run our organization - We can use and share your health information to run our practice, improve your care, and contact you when necessary.
- Bill for services - We can use and share your health information to bill and get payment from health plans or other entities.
- Help with public health and safety issues
- Do research
- Comply with the law
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Address workers' compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
Your Choices
You have the right to request restrictions on certain uses and disclosures of your health information. We are not required to agree to your request, but if we do, we will honor it except in emergency situations.
Our Responsibilities
- Maintain the privacy and security of your protected health information
- Notify you promptly if a breach occurs that may have compromised the privacy or security of your information
- Follow the duties and privacy practices described in this notice
- Notify you of any changes to this notice
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 upon request and on our website.
Contact Information
If you have questions about this notice or want to exercise your rights, please contact:
Privacy Officer
Wellness HealthCare Clinics
Email: compliance.officer@wellnesshealthcare.com
Phone: 555-WELLNESS