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Health Provider Notices of Privacy Practices
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.
Youthful MD, LLC is required by law to provide you with this privacy notice (“Notice”) to explain how we protect your health information. This notice also outlines your rights regarding your health information and how we may use or disclose it. Youthful MD, LLC must abide by the terms of this notice.
The Health Insurance Portability and Accountability Act (“HIPAA”) ensures privacy protections for your healthcare information. There may be other federal and state privacy laws applicable to you. Youthful MD, LLC, its employees, contractors, business associates, and affiliates (referred to as “we”, “us”, or “our”) follow this Notice.
Youthful MD, LLC reserves the right to change our privacy practices and the terms of this Notice. We will inform you of any significant changes either by direct mail or electronically, as required by law.
To protect your information from risks such as loss, destruction, or misuse, Youthful MD, LLC employs physical, electronic, and procedural security safeguards in compliance with all applicable state and federal standards.
Information and Protected Health Information (“PHI”)
For the purposes of this Notice, “information”, “PHI”, or “health information” refers to any information that can identify you and relates to your physical or mental health condition, healthcare services provided to you, or payment for such services. PHI includes any data created, received, stored, or transmitted by HIPAA-covered entities and their business associates.
Access to Your Medical Record
You can request an electronic or paper copy of your medical record and other health information we have about you. We will provide it within 30 days of your request and may charge a reasonable, cost-based fee.
Correct or Amend Your Medical Record
You can ask us to correct any information you think is incorrect or incomplete. Requests must be in writing, identifying the specific information to be corrected and the reasons for the amendment. We may decline but will provide a written explanation within 60 days.
Confidential Communications
You can request that we contact you in a specific way or send mail to a different address. We will try to accommodate all reasonable requests.
Limit or Restrict Information Sharing
You can ask us not to use or share certain health information for treatment, payment, or operations. While we will try to honor your request, we are not required to comply.
Accounting of Disclosures
You can request a list of times we’ve shared your health information, with whom, and why, for up to six years prior to the request date. This accounting excludes certain disclosures and is provided once per year for free, with a fee for additional requests.
Copy of This Notice
You can request a paper copy of this notice at any time, even if you agreed to receive it electronically.
Designate Someone to Act for You
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
File a Complaint
If you feel your rights are violated, you can file a complaint with Youthful MD, LLC or with the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you for filing a complaint.
You have the right to tell us your preferences about sharing information in certain situations, such as with family or during disaster relief. If you cannot tell us your preference, we may share your information if it is in your best interest.
We will not share your PHI without your written permission in cases involving marketing, sale of your information, or psychotherapy notes.
Our Uses and Disclosures
We have the right to use and disclose your PHI to:
- Provide treatment to you.
- Run our organization and improve your care.
- Bill for your services.
- Notify you about treatment alternatives or other health benefits.
- Comply with public health and safety issues, research, law enforcement, and other legal requirements.
We are required by law to maintain the privacy and security of your PHI. We will inform you promptly if a breach occurs. We will not use or share your information other than as described here unless you give us written permission. You can revoke this permission at any time with written notice.
For more information, visit (www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html).
Compliance with Certain State Laws
We apply state laws that provide greater rights or protections for your PHI when they are not in conflict with federal privacy regulations.
Additional Restrictions on Use and Disclosure
Certain federal and state laws may require special privacy protections for highly confidential information, such as mental health records, HIV/AIDS information, and genetic tests.
For any questions or concerns regarding this Policy or your privacy rights, contact us at:
Youthful MD, LLC
401 E Las Olas Blvd, Suite 130 PBM135
Fort Lauderdale, FL 33301
Email: info@youthfulmd.com
Phone: 855-411-2225
