Weight No More
Affordable Medical Weight Control
Professional medical weight control does not need to be expensive to be effective!
$90 every 4 weeks., includes generic medications
(some medication slightly higher)
nothing else to buy.
WE ACCEPT CASH, CREDIT & DEBIT
NOTICE OF PRIVACY PRACTICES
Robert W. Krause, M.D. dba Weight No More (herein described as WNM)
Effective date of this notice: This notice was published and becomes effective Sept. 23, 2013
Patty Rodriguez, Privacy Officer, 707-462-0464
PLEASE CAREFULLY REVIEW THIS NOTICE. THIS NOTICE DESCRIBES HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION AND HOW YOU MAY GAIN ACCESS TO YOUR MEDICAL INFORMATION.
Your Protected Health Information (herein referred to as PHI) is individually identifiable information about you, including demographic information, that relates to your past, present or future physical or mental health or condition and related health care services. This is your Health Information Privacy Notice from Weight No More. PLEASE READ IT CAREFULLY. This Notice describes how we may use and disclose your PHI to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control.
We are a small office and appreciate your input. If you have any suggestions as to how you think we might better protect your privacy, please speak to anyone on our staff.
Uses and Disclosures of PHI
Your PHI may be used and disclosed by your medical provider and our office staff for the purpose of providing health care services to you. Your PHI may also be used and disclosed for payment and to enable us to meet our professional and legal obligations to operate this medical practice properly.
We protect your PHI from inappropriate use or disclosure. Our employees, and those of companies that help us serve you, are required to comply with all HIPAA requirements that protect the confidentiality of PHI. WNM collects health information about you and stores it in a chart and electronically through a program run by md-scripts.
These are simply examples, and are not meant to be exhaustive.
Treatment: We will use and disclose your PHI to provide, coordinate, or manage your health care and medical record. All of our employees have signed a confidentially agreement.
Payment: Since payment is made at time of service by cash or credit card, no disclosure to any health insurance plan is made. If you require a receipt for HSA or employer subsidy plan, we will provide it. As soon as the receipt is in your possession, we have no further duty to protect the PHI on your receipt. If you pay by credit or debit card, your card information will be transmitted and Weight No More will appear on your statement.
Health Care Operations: We may use or disclose, as needed, your PHI in order to support the business activities of your physician’s practice. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing, filing legally required reports, maintaining inventory of controlled substances and compliance activities related to HIPAA. We will have you sign a sign in sheet when you arrive at our office. We make every effort to keep this private but in rare instances, someone may see your name. We may also call out your name. We will make every effort to use your first name only, but occasionally both first and last name can legally be used.
We will share your PHI with third party “business associates” that perform various activities (for example, billing) for our practice. Whenever an arrangement between our office and a business associate involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy of your PHI under HIPAA. Under California law all recipients of PHI are prohibited from disclosing PHI except as specifically required or permitted by law.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Agree or Object:
We may use or disclose your PHI in the following situations without your authorization or providing you the opportunity to agree or object. These situations include:
As Required By Law: We may use or disclose your PHI to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if required by law, of any such uses or disclosures.
Public Health: We may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. For example, a disclosure may be made for the purpose of preventing or controlling disease, injury or disability.
Communicable Diseases: We may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, other government regulatory programs and civil rights laws, subject to the limitations imposed by federal or California law.
Abuse or Neglect: We may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your PHI if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your PHI to a person or company as required by the Food and Drug Administration for the purpose of quality, safety, or effectiveness of FDA-regulated products or activities such as to report adverse events, product defects or problems, to track products, to enable product recalls, or to conduct post marketing surveillance, as required.
Law Enforcement and legal proceedings: We may disclose PHI, without your prior written authorization, under specific circumstances to law enforcement officials or for law enforcement purposes. The reasons we would disclose your PHI to law enforcement officials or for law enforcement purposes include: (1) to comply with a court order or court-ordered warrant, subpoena, or summons issued by a judicial officer, or a grand jury subpoena; (2) to respond to an administrative request, such as from an investigative demand or written request from a law enforcement official; (3) to respond to a request for PHI for purposes of identifying or locating a suspect, fugitive, material witness, or missing person; (4) to respond to a request for information about a victim of a crime if the victim agrees; (5) to report protected information to law enforcement in any case as required by law; (6) to report PHI that we believe in good faith to be evidence of a crime that occurred on our premises; (7) to respond to an off-site medical emergency, as necessary.
Coroners or Organ Donation: We may disclose PHI to a coroner determining cause of death or for the coroner to perform other duties authorized by law. PHI may be used and disclosed for organ or tissue donation purposes.
Research: We may disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose PHI of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military command authorities. We may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities if required by law.
Fundraising and sale of Protected Health Information: We will never use your PHI for fundraising activities or advertising. We will never sell your PHI for any reason in any circumstance.
Other Permitted and Required Uses and Disclosures That Require Providing You the Opportunity to Agree or Object:
Others Involved in Your Health Care or Payment for your Care: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care.
Marketing Communications: Marketing is defined as providing a product or service that encourage recipients of the communication to purchase or use the product or service. 1.we will never disclose PHI to any entity for direct or indirect remuneration or for another entity to communicate with our patients about their product or services. 2. Our medical provider may provide you with suggestions of products or services he or she believes may benefit your treatment ONLY if neither your provider or WNM receives no compensation for the suggestion.
When this Medical practice may not use or disclose your health information
Except as described in this notice of privacy practices, this medical practice will not use or disclose health information which identifies you without your written authorization.
Your Health Information Rights
You have the right to request a restriction of your PHI.
You have the right to request a limitation of certain uses and disclosures of your health information, by a written request specifying what information you want to limit and what limitations on our use or disclosure of that information you wish to have imposed. We reserve the right to accept or reject your request, and will you notify you of our decision.
You have the right to request or to receive confidential communication from us by alternative means or at an alternative location We will accommodate reasonable requests. To expedite this, we are providing you a form to complete indicating how you wish (or do not wish) to be contacted.
You have the right to inspect and copy your Protected Health Information.
You have the right to inspect or copy your PHI, with limited exceptions. We have a government approved form for you to make this request and the law requires you to provide identification (such as a driver’s license) We will only provide a paper copy. By law, we are not responsible for any disclosures of your PHI which you request after the record leaves our office.
You may have the right to have your physician amend your PHI. You have a right to request that we amend health information that you believe is incorrect or incomplete. You must make a request to amend in writing and include the reasons you believe the information is inaccurate or incomplete. We are not required to change your health information, and will provide you with information about why we denied the change and how you can disagree with this denial. You also have the right to request that we add to your record a statement of up to 250 words concerning any statement or item you believe to be incomplete or incorrect.
You have the right to receive an accounting of certain disclosures we have made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice. It excludes disclosures we may have made to you if you authorized us to make the disclosure, to family members or friends involved in your care, or for notification purposes, for national security or intelligence or law enforcement (as provided in the privacy rule), or as part of a limited data set disclosure. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations. You must make this request in writing and this request must include a time frame, which may not be longer than six (6) years.
You have the right to obtain a paper copy of this notice from us.
We will notify any affected individuals if we ever discover a breach of your PHI. In the event of a breach of your PHI, we will provide you with notice in written form by first-class mail. If we have insufficient or out-of-date contact information for you, we may provide you with notice by an alternative form of written, telephone, or other notice. Such individual notification shall be provided without unreasonable delay and, in all cases, within five business days following the discovery of a breach and will include the following, to the extent possible: a breach description; a description of the information types involved in the breach; the steps, if any, you should take to protect yourself from potential harm; a description of what steps we are taking to investigate the breach, mitigate the harm, and prevent further breaches; and information on how to contact us.
Most complaints can be resolved by our office. If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with us. Please put all details of your complaint in writing so that we will completely understand how to investigate your complaint. Give the written complaint to anyone on our staff, and it will be immediately communicated to our privacy officer and to Doctor Krause. Any complaint will have the highest priority, and we will investigate it promptly and keep you informed. You will never be penalized for making a complaint.
If you are not satisfied with the manner in which this office handles your complaint you may submit a formal complaint to:
The Department of Human Services
Office of Civil Rights
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
Effective Date of This Notice
This notice was published and becomes effective on September 23, 2013.
Changes to this Notice of Privacy Practices. We reserve the right to amend this Notice of Privacy Practices at any time in the future. After an amendment is made the revised Notice of Privacy Practices will apply to all PHI that we maintain, regardless of when it was created or received. We will keep a copy of the current notice posted in our reception area, and a copy will be available upon request.